Individual
MR. DARIAN WADE LONG I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 HIGHWAY VV, KENNETT, MO 63857
(573) 888-5925
(573) 888-9365
Mailing address
925 HIGHWAY VV, KENNETT, MO 63857-0071
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
8162
MO
Other
Enumeration date
11/10/2014
Last updated
11/10/2014
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