Individual
TAMARA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1813 DOLPHIN DR, PORTLAND, TX 78374-2721
(361) 232-3770
Mailing address
PO BOX 220, PORTLAND, TX 78374-0220
(361) 445-4643
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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