Individual
TIANNA L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
439 FASSEN ST, SAINT LOUIS, MO 63111-1912
(314) 484-1846
Mailing address
8204 GRAVOIS RD, SAINT LOUIS, MO 63123-4725
(314) 405-1114
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
X137003006
MO
Other
Enumeration date
02/08/2018
Last updated
02/08/2018
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