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1689768707
RANDALL DEAN WALLACE
CAMBRIDGE, MN
NPI
1689768707
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
103T00000X Psychologist
(Licence: MN LP0683)
Enumeration Date
2006-10-03
Last Update Date
2007-07-08
Business Address
Mr. RANDALL DEAN WALLACE M.S.
133 2ND AVE SW
CAMBRIDGE, MN 55008-1552
Phone number: 763-689-9407
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Mailing Address
Mr. RANDALL DEAN WALLACE M.S.
199 COON RAPIDS BLVD NW SUITE 306
COON RAPIDS, MN 55433-5831
Phone number: 763-780-1520
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