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1518391135
KEVIN WALLACE
MODESTO, CA
NPI
1518391135
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225700000X Massage Therapist
(Licence: CA 48846)
Enumeration Date
2013-08-30
Last Update Date
2013-08-30
Business Address
-- KEVIN WALLACE
817 COFFEE RD STE D
MODESTO, CA 95355-4241
Phone number: 209-527-6100
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Mailing Address
-- KEVIN WALLACE
817 COFFEE RD STE D
MODESTO, CA 95355-4241
Phone number: 209-527-6100
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