Individual
MRS. KELLY ANN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
727 CARMEN DR, NORRISTOWN, PA 19401-3545
(484) 250-1970
Mailing address
727 CARMEN DRIVE, NORRISTOWN, PA 19401
(484) 250-1970
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OCO11666
PA
Other
Enumeration date
03/14/2013
Last updated
03/14/2013
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