Individual
MR. JEROLD HORACE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5001 N PIEDRAS ST, EL PASO, TX 79930-4210
(915) 564-7963
(915) 564-7920
Mailing address
5001 N PIEDRAS ST, EL PASO, TX 79930-4210
(915) 564-7963
(915) 564-7920
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
X-07564
NM
Other
Enumeration date
11/07/2011
Last updated
11/07/2011
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