Individual
MRS. VICKY WILDERMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
829 FRONT ST STE H, GEORGETOWN, SC 29440-3564
(843) 323-5560
(843) 388-5204
Mailing address
1470 BEN SAWYER BLVD STE 7, MOUNT PLEASANT, SC 29464-4593
(843) 323-5560
(843) 388-5204
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1483
SC
Other
Enumeration date
10/21/2008
Last updated
10/28/2008
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