Individual
TRACY BRUCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 HOSPITAL RD, TUSKEGEE, AL 36083-5001
(334) 727-0550
Mailing address
6280 DEERWOOD DR, MONTGOMERY, AL 36117-4559
(334) 399-1036
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4885G
AL
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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