Most Relevant Information
Provider Data
| NPI Number: | 1003415217 |
| Provider Name: | WANDA S MASSIE |
| Entity Type: | Individual |
| Taxonomy Code: | 251X00000X |
| Specialty: | Supports Brokerage |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/19/2020 |
| Last Updated: | 10/19/2020 |
Provider Practice Location
3081 CROSS RD
WINCHESTER
OH
456979749
Practice Location Phone/Fax
| Phone: | 9372173341 |
| Fax: |
Provider Mailing Location
3081 CROSS RD
WINCHESTER
OH
456979749
Provider Mailing Phone/Fax
| Phone: | 9372173341 |
| Fax: |