Individual
TYLER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7785 KESWICK PL, SAINT LOUIS, MO 63119
(573) 344-7009
Mailing address
1900 MCNATT DR APT 1, BROOKLAND, AR 72417-9024
(573) 344-7009
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/30/2016
Last updated
06/18/2018
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