Individual
TARA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4405 JUNE AVE, SAINT LOUIS, MO 63121-3232
(314) 456-4284
Mailing address
4405 JUNE AVE, SAINT LOUIS, MO 63121-3232
(314) 456-4284
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/24/2020
Last updated
09/24/2020
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