Individual
MS. KACEY L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7975 MOUNT HOOD, DAYTON, OH 45424-6932
(937) 919-8330
Mailing address
7975 MOUNT HOOD, DAYTON, OH 45424-6932
(937) 919-8330
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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