Individual
MARY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
144 EVERGREEN PKWY, LEBANON, MO 65536-7056
(217) 222-6800
(636) 528-7335
Mailing address
1549 NORTHBROOK ST, LEBANON, MO 65536-4319
(217) 222-6800
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2007022074
MO
Other
Enumeration date
07/21/2017
Last updated
07/21/2017
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