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1720401789
GLENN WILSON
HOLLOMAN AFB, NM
NPI
1720401789
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1003X Military Health Care Provider Independent Duty Medical Technicians
Enumeration Date
2014-01-28
Last Update Date
2024-03-29
Business Address
GLENN WILSON IDMT
280 DAVID L GOLDFEIN ST BLDG 23
HOLLOMAN AFB, NM 88330-8273
Phone number: 707-424-5107
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Mailing Address
GLENN WILSON IDMT
228 SEABURY ST
SUISUN CITY, CA 94585-4107
Phone number:
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