Individual
KEITH C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
2503 ROBIN KNOLL CT, FRESNO, TX 77545-8167
(281) 509-2017
Mailing address
2503 ROBIN KNOLL CT, FRESNO, TX 77545-8167
(281) 509-2017
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00410
TX
Other
Enumeration date
10/16/2008
Last updated
10/31/2016
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