Organization
ONE SOURCE HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURICE AYIDIYA (OWNER)
(314) 304-3591
Entity
Organization
Contact information
Practice address
3430 EVERGREEN LN, APT E, SAINT LOUIS, MO 63125-4804
(314) 304-3591
Mailing address
3430 EVERGREEN LN, APT E, SAINT LOUIS, MO 63125-4804
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1
MO
Other
Enumeration date
05/21/2007
Last updated
08/22/2020
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