Organization
ALTA WELLNESS LLC
Active
Other names
Foot Solutions
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIS HERALD WAGNER (OWNER)
(210) 930-5505
Entity
Organization
Contact information
Practice address
1201 N LOOP 1604 W, SUITE 117, SAN ANTONIO, TX 78258-4597
(210) 493-3338
Mailing address
602 ALTA AVE, SAN ANTONIO, TX 78209-4432
(210) 930-5505
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/30/2009
Last updated
07/20/2010
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