Individual
IRA VATS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 PARK AVE, SAINT LOUIS, MO 63104-3024
(866) 626-2878
Mailing address
4420 W 150TH ST, LEAWOOD, KS 66224-9546
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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