Organization
THE OUTLET PLACE FOR WOMEN
Active
Other names
Outlet Place for Women The
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DETRONNE COULSON (PRESIDENT)
(816) 984-4841
Entity
Organization
Contact information
Practice address
1308 W TRUMAN RD, INDEPENDENCE, MO 64050-3433
(816) 984-4841
Mailing address
3401 BROADWAY ST # 16, KANSAS CITY, MO 64111-2403
(816) 984-4841
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/01/2011
Last updated
09/01/2011
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