Individual
EDWARD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1955 LONG BEACH BLVD, LONG BEACH, CA 90806-5501
(562) 320-2426
Mailing address
100 W BROADWAY, SUITE 5010, LONG BEACH, CA 90802-4431
(562) 285-1330
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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