Individual
MRS. DIANE ALICE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
307 N PINEVIEW ST, STANBERRY, MO 64489-1509
(660) 783-2118
Mailing address
307 N PINEVIEW ST, STANBERRY, MO 64489-1509
(660) 783-2118
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MO00988
MO
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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