Alex Wilson

NPI #1104294073 in Kennett, Missouri

Provider Information

NPI Number: 1104294073
Entity Type: Individual
Name: Alex Wilson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Sep 9, 2015
Last Updated: Sep 9, 2015

Practice Location

Address: 1109 JONES ST
City: Kennett
State: Missouri
ZIP Code: 63857-3824
Phone: (573) 888-6454

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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