Individual
MR. THOMAS GERARD MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1430 OLIVE ST, SUITE 500, SAINT LOUIS, MO 63103-2303
(314) 422-7630
Mailing address
1430 OLIVE ST, SUITE 500, SAINT LOUIS, MO 63103-2303
(314) 422-7630
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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