MALLORY ANTONETTA WILSON

TWIN FALLS, ID
NPI1730923699
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID  13044)
Enumeration Date2024-06-24
Last Update Date2024-06-24
Business Address
MALLORY ANTONETTA WILSON SUDA
630 ADDISON AVE W STE 1000
TWIN FALLS, ID 83301-5853
Phone number: 208-736-5048
Mailing Address
MALLORY ANTONETTA WILSON SUDA
630 ADDISON AVE W STE 1000
TWIN FALLS, ID 83301-5853
Phone number: 208-736-5048
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