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1376184408
PATRICK WALLACE
SAN DIEGO, CA
NPI
1376184408
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2019-09-30
Last Update Date
2019-09-30
Business Address
PATRICK WALLACE
4104 DELTA ST
SAN DIEGO, CA 92113-4113
Phone number: 619-264-0141
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Mailing Address
PATRICK WALLACE
4104 DELTA ST
SAN DIEGO, CA 92113-4113
Phone number:
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