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1083700231
ALEXIS DAWN WAGONER
LONGVIEW, WA
NPI
1083700231
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
126800000X Dental Assistant
Enumeration Date
2006-10-05
Last Update Date
2007-07-08
Business Address
Mrs. ALEXIS DAWN WAGONER da
3902 COTTONWOOD ST
LONGVIEW, WA 98632-4911
Phone number: 360-425-7753
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Mailing Address
Mrs. ALEXIS DAWN WAGONER da
3902 COTTONWOOD ST
LONGVIEW, WA 98632-4911
Phone number: 360-425-7753
Copy
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