Individual
GRACE VANDER LEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 S FORT AVE, SPRINGFIELD, MO 65807-3480
(417) 882-0035
Mailing address
303 E CENTER ST APT 612, ROGERSVILLE, MO 65742-7787
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2015028669
MO
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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