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1386903771
LISA JANE WAGONER
LAKE VILLAGE, AR
NPI
1386903771
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Former Name
LISA JANE SNOW
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2012-05-07
Last Update Date
2012-05-07
Business Address
-- LISA JANE WAGONER MHPP
316 MAIN ST
LAKE VILLAGE, AR 71653-1942
Phone number: 870-265-2186
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Mailing Address
-- LISA JANE WAGONER MHPP
316 MAIN ST
LAKE VILLAGE, AR 71653-1942
Phone number: 870-265-2186
Copy
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