Individual
ANGELINA M WILLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3330 LACLEDE AVE, CHAIFETZ ARENA, SAINT LOUIS, MO 63103-2014
(314) 977-7018
(314) 977-3183
Mailing address
3330 LACLEDE AVE, CHAIFETZ ARENA, SAINT LOUIS, MO 63103-2014
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2005005317
MO
Other
Enumeration date
06/28/2012
Last updated
06/28/2012
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