CHARLES WALLACE WICKLIFFE

LOS ANGELES, CA
NPI1871663054
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225800000X Recreation Therapist
Enumeration Date2006-11-08
Last Update Date2007-07-08
Business Address
Mr. CHARLES WALLACE WICKLIFFE
11301 WILSHIRE BLVD 117R
LOS ANGELES, CA 90073-1003
Phone number: 310-478-3711
Mailing Address
Mr. CHARLES WALLACE WICKLIFFE
5274 PARKGLEN AVE
LOS ANGELES, CA 90043-1030
Phone number: 323-299-9755
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