Individual
MARTHA JANE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBP
Contact information
Practice address
300 N DALTON AVE, VALLIANT, OK 74764-0673
(580) 933-7031
(580) 933-7034
Mailing address
PO BOX 673, VALLIANT, OK 74764-0673
(580) 933-7031
(580) 933-7034
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0277
OK
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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