Individual
MR. JOE RANDALL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
2171 N FINE AVE, FRESNO, CA 93727-1519
(559) 455-2000
(559) 455-2041
Mailing address
2171 N FINE AVE, FRESNO, CA 93727-1519
(559) 455-2000
(559) 455-2041
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
—
—
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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