Individual
TEQUILA DIONTA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1169 N HIGHWAY 67 ST, FLORISSANT, MO 63031-4701
(314) 733-5683
(314) 733-5684
Mailing address
2460 CENTER AVE, SAINT LOUIS, MO 63136-3916
(314) 393-7395
(314) 733-5684
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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