Individual
AMANDA GRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0131
Mailing address
14044 HIGHWAY 32, SUCCESS, MO 65570-9748
(573) 596-0131
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
2008028847
MO
Other
Enumeration date
11/13/2015
Last updated
11/13/2015
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