Individual
ADAM CLAY WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
34101 FARENHOLT AVE, SAN DIEGO, CA 92134-7000
(619) 532-7968
Mailing address
767 COLON RD, GRAND RIVERS, KY 42045-9105
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/19/2019
Last updated
02/19/2019
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