Individual
LAWRENCE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4950 S INDIAN CREEK RD, PRESCOTT, AZ 86303-6180
(928) 445-7690
Mailing address
PO BOX 54, PRESCOTT, AZ 86302-0054
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Enumeration date
01/04/2011
Last updated
01/04/2011
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