Individual
CHRISTINA LANESE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
38 WHISPERING DR, TROTWOOD, OH 45426-3027
(937) 204-8455
Mailing address
38 WHISPERING DR, TROTWOOD, OH 45426-3027
(937) 204-8455
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
SC859513
OH
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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