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1477262590
SHANTONITT WALLACE
VALDOSTA, GA
NPI
1477262590
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171W00000X Contractor
Enumeration Date
2022-11-17
Last Update Date
2022-11-17
Business Address
SHANTONITT WALLACE
2209 PULASKI CIR
VALDOSTA, GA 31602-7312
Phone number: 229-618-0021
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Mailing Address
SHANTONITT WALLACE
2209 PULASKI CIR
VALDOSTA, GA 31602-7312
Phone number: 229-618-0021
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