Individual
TODD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22721 E STATE HIGHWAY 31, QUINTON, OK 74561-5107
(918) 469-2884
Mailing address
22721 E STATE HIGHWAY 31, QUINTON, OK 74561-5107
(918) 469-2884
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/28/2013
Last updated
08/28/2013
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