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1770148587
AUTUMN VICTORIA WALLACE
GONZALES, LA
NPI
1770148587
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Other Name
AUTUMN MOORE
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
106S00000X Behavior Technician
Enumeration Date
2019-05-07
Last Update Date
2019-05-07
Business Address
AUTUMN VICTORIA WALLACE
1028 E WORTHY ST
GONZALES, LA 70737-4367
Phone number: 504-399-9851
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Mailing Address
AUTUMN VICTORIA WALLACE
21600 OXNARD ST STE 1800
WOODLAND HILLS, CA 91367-7807
Phone number: 818-345-2345
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