BLAKE MERRICK TRAVIS

SAINT LOUIS, MO
NPI1144044488
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
(Licence: MO  2021032187)
Enumeration Date2024-11-13
Last Update Date2024-11-13
Business Address
BLAKE MERRICK TRAVIS
2705 WYOMING ST
SAINT LOUIS, MO 63118-2333
Phone number: 425-495-2490
Mailing Address
BLAKE MERRICK TRAVIS
2705 WYOMING ST
SAINT LOUIS, MO 63118-2333
Phone number: 425-495-2490