Organization
GOLLIHAR'S SHOE STORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY ALLEN CLARK CERTIFIED PEDORTHIST (PRESIDENT)
(573) 378-4652
Entity
Organization
Contact information
Practice address
105 N MONROE ST, VERSAILLES, MO 65084-1216
(573) 378-4652
Mailing address
105 N MONROE ST, VERSAILLES, MO 65084-1216
(573) 378-4652
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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