Individual
MICHELLE MARIE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
340 HARWOOD AVE, LEBANON, MO 65536-2318
(417) 991-2221
Mailing address
340 HARWOOD AVE, LEBANON, MO 65536-2318
(417) 991-2221
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
Z164274002
MO
172A00000X
Driver
—
MO
Other
Enumeration date
03/08/2024
Last updated
03/08/2024
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