Individual
LISA RENEE BURNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 EMINENCE AVE, SAINT LOUIS, MO 63134-3420
(314) 363-1853
Mailing address
4400 EMINENCE AVE, SAINT LOUIS, MO 63134-3420
(314) 363-1853
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
LC9821011
MO
Other
Enumeration date
03/08/2017
Last updated
03/08/2017
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