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Individual

WILLIAM CONNOR IMBODEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MAT, ATC, LAT

Contact information

Practice address
123 LEON HALL PKWY # 3419, HILLSBORO, MO 63050-3419
(217) 204-2400
Mailing address
2208 BENSON RD, JACKSONVILLE, IL 62650-6547
(217) 204-2400

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2020027571
MO

Other

Enumeration date
12/03/2020
Last updated
12/03/2020
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