Individual
AVIS B GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1716 CORPORATE XING, O FALLON, IL 62269-3734
(302) 334-8216
Mailing address
4240 N EUCLID AVE, SAINT LOUIS, MO 63115-2165
(314) 378-6712
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/30/2022
Last updated
06/30/2022
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