Individual
WANDA YVETTE MCLEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 PONDER PLACE DR, EVANS, GA 30809-3118
(706) 993-6404
Mailing address
3639 OLD PETERSBURG RD APT B, MARTINEZ, GA 30907-2866
(706) 306-8565
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT008329
GA
Other
Enumeration date
01/10/2018
Last updated
01/10/2018
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