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1629843552
SIDIQAT WALLACE
KERNERSVILLE, NC
NPI
1629843552
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2023-11-21
Last Update Date
2023-11-21
Business Address
SIDIQAT WALLACE
770 PARK CENTRE DR
KERNERSVILLE, NC 27284-3598
Phone number: 704-780-4271
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Mailing Address
SIDIQAT WALLACE
770 PARK CENTRE DR
KERNERSVILLE, NC 27284-3598
Phone number: 704-780-4271
Copy
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