JONATHAN DAVID WALLACE

HEFLIN, LA
NPI1770219693
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225X00000X Occupational Therapist
(Licence: LA  OTT.Z12243)
Enumeration Date2022-07-25
Last Update Date2022-07-25
Business Address
JONATHAN DAVID WALLACE LOTR
870 HIGHWAY 516
HEFLIN, LA 71039-3726
Phone number: 318-614-5684
Mailing Address
JONATHAN DAVID WALLACE LOTR
870 HIGHWAY 516
HEFLIN, LA 71039-3726
Phone number:
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