Organization
KKW MASSAGE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN K WAGNER (PRESIDENT)
(360) 690-4114
Entity
Organization
Contact information
Practice address
7904 NE 6TH AVE, SUITE C, VANCOUVER, WA 98665-8150
(360) 690-4114
Mailing address
7904 NE 6TH AVE, SUITE C, VANCOUVER, WA 98665-8150
(360) 690-4114
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MA000015471
WA
Other
Enumeration date
03/04/2009
Last updated
03/04/2009
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