Individual
GRANT THOMAS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1407 N MICHIGAN ST, PLYMOUTH, IN 46563-1119
(574) 941-2220
Mailing address
PO BOX 562, ROCHESTER, IN 46975-0562
(574) 223-2167
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
17001521A
IN
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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