Individual
CHONG IM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
6403 88TH STREET CT SW, APT 12, LAKEWOOD, WA 98499-2695
(253) 503-9527
Mailing address
6403 88TH STREET CT SW, APT 12, LAKEWOOD, WA 98499-2695
(253) 503-9527
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA60116023
WA
Other
Enumeration date
07/16/2010
Last updated
07/16/2010
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