| NPI | 1861405805 |
|---|---|
| Doing Business As | DAVID WILSON, LSA, CST/CFA |
| Entity Type | Organization |
| Authorized Contact | CAROLYN YVONNE HACKNEY Billing Manager 817-800-8386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA0007) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |