Individual
CHARLES EDWARD WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8091 SW 4TH ST, BLUE SPRINGS, MO 64014-7846
(314) 496-3230
Mailing address
8091 SW 4TH ST, BLUE SPRINGS, MO 64014-7846
(314) 496-3230
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
04/11/2019
Last updated
04/11/2019
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