Individual
MICHAEL BOSWELL DIFFLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1402 S GRAND BLVD # M260, SAINT LOUIS, MO 63104-1004
(817) 713-4646
Mailing address
2211 SPANISH TRL, FORT WORTH, TX 76107-3579
(817) 713-4647
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/22/2018
Last updated
03/22/2018
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