Individual
JENNIFER R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
3394 N US HIGHWAY 259, LONGVIEW, TX 75605-5086
(903) 663-0061
Mailing address
200 DELWOOD DR, LONGVIEW, TX 75605-3374
(903) 495-2613
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT110646
TX
Other
Enumeration date
11/08/2010
Last updated
11/08/2010
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