Individual
PAMELA G WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
14004 SE 202ND ST, KENT, WA 98042-3017
(253) 691-0611
Mailing address
14004 SE 202ND ST, KENT, WA 98042-3017
(253) 691-0611
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA 00023593
WA
Other
Enumeration date
02/07/2011
Last updated
02/07/2011
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