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1427752245
TEQUILA DIONTA CLARK
FLORISSANT, MO
NPI
1427752245
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
251E00000X Home Health
Enumeration Date
2023-03-27
Last Update Date
2023-03-27
Business Address
TEQUILA DIONTA CLARK
1169 N HIGHWAY 67 ST
FLORISSANT, MO 63031-4701
Phone number: 314-733-5683
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Mailing Address
TEQUILA DIONTA CLARK
2460 CENTER AVE
SAINT LOUIS, MO 63136-3916
Phone number: 314-393-7395
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