Individual
TYRELL SCURLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11960 WESTLINE INDUSTRIAL DR, 201, SAINT LOUIS, MO 63146-3209
(314) 575-8163
Mailing address
PO BOX 23331, SAINT LOUIS, MO 63156-3331
(314) 575-8163
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2003020843
MO
Other
Enumeration date
04/08/2015
Last updated
04/08/2015
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