Provider Information for 1134568397
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ALEISA KEELS WILSON
Sex: Female
NPI: 1134568397
Last Updated: 2013-06-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134568397 | ||||||||||||
| Enumeration Date | 2013-06-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 305 FARM SPRINGS RD MOUNT HOLLY, NC 28120-3022 United States Phone: 704-822-1121 | Fax: | ||||||||||||
| Primary Practice Address | 1601 BRENNER AVE SALISBURY, NC 28144-2515 United States Phone: 954-249-6199 | Fax: | ||||||||||||
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