Individual
MRS. SANDRA JEAN WIEGAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9035 W MARY ANN DR, PEORIA, AZ 85382-6459
(623) 692-1979
Mailing address
9035 W MARY ANN DR, PEORIA, AZ 85382-6459
(623) 692-1979
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
11786
AZ
Other
Enumeration date
02/19/2008
Last updated
02/19/2008
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