Individual
MR. LANCE WAYNE WILKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, CSCS, PES
Contact information
Practice address
101 HILLSIDE DR, INGRAM, TX 78025-3126
(830) 367-2803
Mailing address
101 HILLSIDE DR, INGRAM, TX 78025-3126
(830) 367-2803
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT1583
TX
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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