Individual
MRS. LAURA ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8129 WHEELER DR, ORLAND PARK, IL 60462-4928
(708) 460-6412
Mailing address
8129 WHEELER DR, ORLAND PARK, IL 60462-4928
(708) 460-6412
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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