Organization
VITALITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE KYLE MCCOY (OWNER)
(573) 755-0340
Entity
Organization
Contact information
Practice address
111 N. MISSOURI STREET, JACKSON, MO 63755
(573) 755-0340
Mailing address
465 S. MOUNT AUBURN RD, SUITE 103, CAPE GIRARDEAU, MO 63703
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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