Individual
ANTHONY JOSEPH WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3878 BEVERLY AVE NE, BUILDING H, SALEM, OR 97305-1394
(503) 576-4692
Mailing address
5285 SW NASH AVE, CORVALLIS, OR 97333-9312
(503) 459-7199
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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