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Individual

SALLY JO WYATT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMP

Contact information

Practice address
1963 BETHEL RD SE, PORT ORCHARD, WA 98366-3108
(360) 876-3393
Mailing address
PO BOX 403, MANCHESTER, WA 98353-0403
(360) 649-4106

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60083727
WA

Other

Enumeration date
04/30/2009
Last updated
02/10/2010
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