Individual
MR. JOHN ANTHONY WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 W 115TH ST, CHICAGO, IL 60628-5512
(773) 995-0638
Mailing address
9022 S COLFAX AVE, CHICAGO, IL 60617-4025
(773) 995-7858
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
W42546178287
IL
Other
Enumeration date
05/10/2006
Last updated
07/08/2007
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