Individual
TERISE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2757 E MARYLAND AVE, SHERWOOD, AR 72120-3296
(501) 541-5451
Mailing address
2757 E MARYLAND AVE, SHERWOOD, AR 72120-3296
(501) 541-5451
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
915922192
AR
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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