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1477100717
DESIRAE CLARK
KANSAS CITY, MO
NPI
1477100717
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
335E00000X Prosthetic/Orthotic Supplier
Enumeration Date
2019-08-21
Last Update Date
2019-08-21
Business Address
DESIRAE CLARK
5100 LYDIA AVE
KANSAS CITY, MO 64110-2608
Phone number: 826-749-9147
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Mailing Address
DESIRAE CLARK
PO BOX 300564
KANSAS CITY, MO 64130-0564
Phone number: 816-749-9147
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