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1659121952
SHANE WILSON
COLUMBIA, SC
NPI
1659121952
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2024-03-27
Last Update Date
2024-03-27
Business Address
SHANE WILSON
14 RICHLAND MEDICAL PARK DR
COLUMBIA, SC 29203-6877
Phone number: 803-434-3790
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Mailing Address
SHANE WILSON
14 RICHLAND MEDICAL PARK DR
COLUMBIA, SC 29203-6877
Phone number:
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