BLAKE WICKERHAM

RALEIGH, NC
NPI1275959876
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: NC  2254)
Enumeration Date2014-03-07
Last Update Date2014-03-07
Business Address
-- BLAKE WICKERHAM LAT, ATC
3121 WOODS PL
RALEIGH, NC 27607-5231
Phone number: 919-515-2111
Mailing Address
-- BLAKE WICKERHAM LAT, ATC
3121 WOODS PL
RALEIGH, NC 27607-5231
Phone number: 919-515-2111
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