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1871044255
EBONIE WALLACE
DAYTONA BEACH, FL
NPI
1871044255
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2016-10-20
Last Update Date
2021-02-18
Business Address
EBONIE WALLACE
140 S BEACH ST STE 310
DAYTONA BEACH, FL 32114-4409
Phone number: 386-898-6040
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Mailing Address
EBONIE WALLACE
140 S BEACH ST
DAYTONA BEACH, FL 32114-4472
Phone number: 386-898-6040
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