Individual
ASHLEY BONCK WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHR, ATC, LAT
Contact information
Practice address
36 HILL DRIVE, BASKETBALL PRACTICE FACILITY, UNIVERSITY, MS 38677
(662) 915-1375
Mailing address
36 HILL DRIVE, BASKETBALL PRACTICE FACILITY, UNIVERSITY, MS 38677
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0551
MS
Other
Enumeration date
02/03/2012
Last updated
02/03/2012
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