Individual
MS. GAIL RENEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
3245S0500X
OR
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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