Individual
BRIAN LEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1840 NE 104TH LOOP, #7, VANCOUVER, WA 98686-5676
(360) 609-0641
Mailing address
1840 NE 104TH LOOP, #7, VANCOUVER, WA 98686-5676
(360) 609-0641
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60293278
WA
Other
Enumeration date
08/14/2012
Last updated
08/14/2012
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