TIMOTHY BLAKE WILDER

SCOTT AFB, IL
NPI1184858045
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1710I1003X Military Health Care Provider, Independent Duty Medical Technicians
Enumeration Date2009-05-07
Last Update Date2009-05-07
Business Address
-- TIMOTHY BLAKE WILDER IDMT
310 W LOSEY ST
SCOTT AFB, IL 62225-5250
Phone number: 618-256-8970
Mailing Address
-- TIMOTHY BLAKE WILDER IDMT
68 CIRCLE DR
FAIRVIEW HEIGHTS, IL 62208-3303
Phone number: 618-394-3552
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