STANFORD G WALLACE
Nursing at Fordham Ln, Palm Coast, FL

License number
Florida 109959
Issued Date
Jan 19, 2006
Effective Date
Jan 21, 2010
Expiration Date
Dec 31, 2007
Category
Health Care
Type
Certified Nursing Assistant
Address
Address
52 Fordham Ln S/F APT S/F, Palm Coast, FL 32137
Phone
(386) 597-4841
LicenseFiles verified this license of Jun 1, 2017 at the Health Care Practitioner Data Portal.

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