Individual
JOHN LUCAS RUNDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5201 MID AMERICA PLZ, SAINT LOUIS, MO 63129-0002
(217) 663-4090
Mailing address
8861 GILMORE LAKE RD, COLUMBIA, IL 62236-3525
(217) 663-4090
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2015036002
MO
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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