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1861939845
BRIAN WALLACE
SAN DIEGO, CA
NPI
1861939845
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1235971116)
Enumeration Date
2017-01-27
Last Update Date
2018-09-13
Business Address
BRIAN WALLACE RADT 1
7907 OSTROW ST STE F
SAN DIEGO, CA 92111-3635
Phone number: 858-300-8282
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Mailing Address
BRIAN WALLACE RADT 1
7907 OSTROW ST STE F
SAN DIEGO, CA 92111-3635
Phone number: 858-300-8282
Copy
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