Individual
GLENN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
280 DAVID L GOLDFEIN ST BLDG 23, HOLLOMAN AFB, NM 88330-8273
(707) 424-5107
Mailing address
228 SEABURY ST, SUISUN CITY, CA 94585-4107
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
01/28/2014
Last updated
03/29/2024
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