EDISON DERR

SAINT JOSEPH, MO
NPI1861873952
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: MO  2013032471)
Enumeration Date2015-06-15
Last Update Date2015-06-15
Business Address
-- EDISON DERR
2214 MAPLE ST
SAINT JOSEPH, MO 64507-1413
Phone number: 419-651-2323
Mailing Address
-- EDISON DERR
2214 MAPLE ST
SAINT JOSEPH, MO 64507-1413
Phone number: 419-651-2323
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