Individual
DETREECE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4336 MARGARET RIDGE DR, FLORISSANT, MO 63034-3459
(314) 277-0998
Mailing address
4336 MARGARET RIDGE DR, FLORISSANT, MO 63034-3459
(314) 277-0998
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
MO
Other
Enumeration date
10/12/2017
Last updated
10/12/2017
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