Individual
MR. IRA N/A WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
103 S COURT ST, CLEVELAND, MS 38732-2651
(662) 588-5078
Mailing address
103 S COURT ST, CLEVELAND, MS 38732-2651
(662) 588-5078
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1130
MS
Other
Enumeration date
05/22/2012
Last updated
05/22/2012
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