BRIAN WALLACE

SAN DIEGO, CA
NPI1861939845
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  R1235971116)
Enumeration Date2017-01-27
Last Update Date2018-09-13
Business Address
BRIAN WALLACE RADT 1
7907 OSTROW ST STE F
SAN DIEGO, CA 92111-3635
Phone number: 858-300-8282
Mailing Address
BRIAN WALLACE RADT 1
7907 OSTROW ST STE F
SAN DIEGO, CA 92111-3635
Phone number: 858-300-8282
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