Susanne R Wallace

NPI #1881992063 in Great Barrington, Massachusetts

Provider Information

NPI Number: 1881992063
Entity Type: Individual
Name: Susanne R Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Mar 11, 2011
Last Updated: Mar 11, 2011

Practice Location

Address: 442 STOCKBRIDGE ROAD
City: Great Barrington
State: Massachusetts
ZIP Code: 01230
Phone: (413) 644-0104

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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