Individual
WILLIAM CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(703) 309-5012
Mailing address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
08/09/2023
Last updated
08/09/2023
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