Individual
KASSAHUN GEBRESELASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2629 HIGHWAY OO, FARMINGTON, MO 63640-7306
(314) 764-0269
Mailing address
2629 HIGHWAY OO, FARMINGTON, MO 63640-7306
(314) 764-0269
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
W050163003
MO
Other
Enumeration date
05/29/2024
Last updated
05/29/2024
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