DARRELL PROVINSE

SAINT LOUIS, MO
NPI1245380641
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YP2500X Counselor, Professional
(Licence: MO  2004003789)
Enumeration Date2007-01-10
Last Update Date2007-07-08
Business Address
-- DARRELL PROVINSE L.P.C.
9378 OLIVE BLVD STE. 317
SAINT LOUIS, MO 63132-3215
Phone number: 314-994-9344
Mailing Address
-- DARRELL PROVINSE L.P.C.
9378 OLIVE BLVD STE. 317
SAINT LOUIS, MO 63132-3215
Phone number: 314-994-9344
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