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1609859313
SIDNEY WILSON LAVENDER
WINSTON SALEM, NC
NPI
1609859313
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: NC 000100189)
Enumeration Date
2005-11-28
Last Update Date
2010-08-20
Business Address
-- SIDNEY WILSON LAVENDER PAC
MEDICAL CENTER BLVD
WINSTON SALEM, NC 27157-0001
Phone number: 336-716-2255
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Mailing Address
-- SIDNEY WILSON LAVENDER PAC
PO BOX 344
WINSTON SALEM, NC 27102-0344
Phone number: 336-716-2255
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