Individual
MR. EDWIN GEORGE WISNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
2200 TIMBER TRL, BELLEFONTAINE, OH 43311-9039
(937) 592-1625
(937) 592-3489
Mailing address
711 RUSH AVE, BELLEFONTAINE, OH 43311
(937) 592-1625
(937) 592-3489
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT577
OH
Other
Enumeration date
09/07/2006
Last updated
05/13/2016
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