Individual
WILTON HALL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4625 E BROADWAY BLVD STE 114, TUCSON, AZ 85711-3575
(520) 304-5330
Mailing address
933 N MAIN AVE UNIT 131, TUCSON, AZ 85705-7617
(520) 304-5330
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
173C00000X
Reflexologist
Primary
—
—
225700000X
Massage Therapist
—
—
Other
Enumeration date
01/27/2017
Last updated
01/09/2020
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