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1184895070
MARIE A WAGNER
PORT SAINT LUCIE, FL
NPI
1184895070
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
171W00000X Contractor
(Licence: FL 19-3549-004-08)
Enumeration Date
2008-03-18
Last Update Date
2008-03-18
Business Address
Ms. MARIE A WAGNER
365 SW LOG DR
PORT SAINT LUCIE, FL 34953-7501
Phone number: 772-785-6473
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Mailing Address
Ms. MARIE A WAGNER
365 SW LOG DR
PORT SAINT LUCIE, FL 34953-7501
Phone number: 772-785-6473
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