KELLY WALLACE

PHILADELPHIA, PA
NPI1427726793
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor Mental Health
Enumeration Date2021-09-01
Last Update Date2021-09-01
Business Address
MR. KELLY WALLACE
1348 BAINBRIDGE ST
PHILADELPHIA, PA 19147-1810
Phone number: 215-563-0652
Mailing Address
MR. KELLY WALLACE
1348 BAINBRIDGE ST
PHILADELPHIA, PA 19147-1810
Phone number: 215-563-0652
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