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Individual

MR. WILLARD AGNEW III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MS, ATC

Contact information

Practice address
113 JOYCE CTR, NOTRE DAME, IN 46556-5678
(574) 631-7100
Mailing address
113 JOYCE CTR, NOTRE DAME, IN 46556-5678
(574) 631-7100

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001451A
IN

Other

Enumeration date
05/28/2009
Last updated
05/28/2009
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