Individual
MR. EDEFER ANONUEVO DELA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
1514 W LARK ST, SPRINGFIELD, MO 65810-2270
(417) 889-1275
Mailing address
3853 W VINCENT DR, SPRINGFIELD, MO 65810-1061
(417) 823-7854
(417) 823-7854
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2006011989
MO
Other
Enumeration date
09/28/2012
Last updated
09/28/2012
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