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1558057372
QUENTIN WALLACE
JACKSON, MS
NPI
1558057372
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2023-04-14
Last Update Date
2023-04-14
Business Address
QUENTIN WALLACE
4780 I 55 FRONTAGE RD N STE 105
JACKSON, MS 39211-5542
Phone number: 601-956-4816
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Mailing Address
QUENTIN WALLACE
4780 I 55 FRONTAGE RD N STE 105
JACKSON, MS 39211-5542
Phone number: 601-956-4816
Copy
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