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1023399896
LISA MARIE WILSON
MYRTLE BEACH, SC
NPI
1023399896
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: SC 1687)
Enumeration Date
2011-09-07
Last Update Date
2017-03-20
Business Address
LISA MARIE WILSON PA
809 82ND PKWY
MYRTLE BEACH, SC 29572-4607
Phone number: 843-497-5929
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Mailing Address
LISA MARIE WILSON PA
809 82ND PKWY
MYRTLE BEACH, SC 29572-4607
Phone number: 843-692-1752
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