Individual
TERESA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4582 CUMBERLAND RD STE 104, FAYETTEVILLE, NC 28306-2416
(910) 500-3019
(910) 500-3068
Mailing address
584 EXECUTIVE PL STE 202, FAYETTEVILLE, NC 28305-5183
(910) 500-3019
(910) 500-3068
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/04/2019
Last updated
11/29/2021
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