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Individual

KENNETH MONROE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MHO PT SCS ATC

Contact information

Practice address
1355 MAPLE STREET, FARMINGTON, MO 63640
(573) 756-9900
(573) 756-9988
Mailing address
730 JOACHIM ST, FESTUS, MO 63028-1414
(636) 208-8163

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02273
MO

Other

Enumeration date
08/29/2006
Last updated
01/22/2008
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