Individual
HEATH DAVID WILLIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
2620 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3396
(573) 686-5985
Mailing address
1305 SARA LN, DEXTER, MO 63841-8247
(573) 624-5378
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2006001835
MO
Other
Enumeration date
06/03/2006
Last updated
07/08/2007
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