Individual
AMANDA JO WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1106 W 2ND ST, COFFEYVILLE, KS 67337-3816
(620) 515-6280
Mailing address
1106 W 2ND ST, COFFEYVILLE, KS 67337-3816
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/25/2017
Last updated
09/25/2017
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