Organization
LAKE GIRL, INC
Active
Other names
Hometown Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE L WILLER APRN (OWNER)
(314) 322-7017
Entity
Organization
Contact information
Practice address
4581 GRAVOIS RD, HOUSE SPRINGS, MO 63051-1374
(636) 671-9980
(636) 671-9981
Mailing address
4581 GRAVOIS RD, HOUSE SPRINGS, MO 63051-1374
(636) 671-9980
(636) 671-9981
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
138512
MO
Other
Enumeration date
08/14/2014
Last updated
12/21/2023
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