Individual
OLIVIA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3821 COUNTY HIGHWAY 89, VINA, AL 35593-5709
(256) 356-2570
Mailing address
3821 COUNTY HIGHWAY 89, VINA, AL 35593-5709
(256) 356-2570
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
AL
Other
Enumeration date
12/15/2014
Last updated
12/15/2014
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