Individual
KEITH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1823 CHARLOTTE AVE, NASHVILLE, TN 37203-2104
(615) 340-0068
Mailing address
408 HIGHPOINT TER, BRENTWOOD, TN 37027-8841
(615) 500-4639
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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