Individual
MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1628 BUCKTOWN DR, DANVILLE, VA 24543
(434) 548-7762
Mailing address
428 CASCADE RD, CASCADE, VA 24069-3320
(434) 548-7762
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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