Wagoner Holdings PA
NPI #1679236400 in Wake Forest, North Carolina
Provider Information
- NPI Number
- 1679236400
- Entity Type
- Organization
- Organization Name
- Wagoner Holdings PA
- Primary Specialty
- Clinic/Center - Health Service
- Enumeration Date
- Oct 19, 2021
- Last Updated
- Oct 19, 2021
Practice Location
- Address
- 851 WAKE FOREST BUSINESS PARK STE E
- City
- Wake Forest
- State
- North Carolina
- ZIP Code
- 27587-7366
- Phone
- (260) 573-1249
Authorized Official
- Name
- DR. EVAN JONATHON WAGONER, DC
- Title
- OWNER
- Phone
- (260) 573-1249
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Health Service — Health Service |
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