Individual
RANCE MINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HAIR LOSS SPECIALIST
Contact information
Practice address
2901 S JEFFERSON AVE, SAINT LOUIS, MO 63118-1510
(314) 323-5143
Mailing address
2901 S JEFFERSON AVE, SAINT LOUIS, MO 63118-1510
(314) 323-5143
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
47-3432321
MO
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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