JACK FENNEL

FORT LEONARD WOOD, MO
NPI1356300271
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: MO  R9D28)
Additional Taxonomies207QA0505X Family Medicine, Adult Medicine
(Licence: MO  R9D28)
Enumeration Date2006-03-20
Last Update Date2007-07-08
Business Address
-- JACK FENNEL DO
126 MISSOURI AVE
FORT LEONARD WOOD, MO 65473-8952
Phone number: 573-329-8305
Mailing Address
-- JACK FENNEL DO
126 MISSOURI AVE
FORT LEONARD WOOD, MO 65473-8952
Phone number: 573-329-8305