Individual
KIARA DANIELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DRIVER
Contact information
Practice address
3207 ADAMS ST, BELLWOOD, IL 60104-2233
(708) 488-6667
Mailing address
3207 ADAMS ST, BELLWOOD, IL 60104-2233
(708) 488-6667
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
W425-5048-9626
IL
Other
Enumeration date
07/14/2022
Last updated
08/18/2022
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