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Individual

MR. RANDALL MONTEAL EVANS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
226 BRUCE AVE, FERGUSON, MO 63135-2704
(314) 372-5011
Mailing address
226 BRUCE AVE, FERGUSON, MO 63135-2704
(314) 372-5011

Taxonomy

Speciality
Code
Description
License number
State
372500000X
Chore Provider
372600000X
Adult Companion
374T00000X
Religious Nonmedical Nursing Personnel
374U00000X
Home Health Aide
Primary

Other

Enumeration date
05/11/2017
Last updated
05/11/2017
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