Individual
LAVELLE WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
198 PARKWAY CIR, WEST MONROE, LA 71292-8032
(318) 600-4225
Mailing address
198 PARKWAY CIR, WEST MONROE, LA 71292-8032
(318) 600-4225
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/20/2023
Last updated
02/20/2023
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