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1912303405
DARIAN WADE LONG
KENNETT, MO
NPI
1912303405
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
(Licence: MO 8162)
Enumeration Date
2014-11-10
Last Update Date
2014-11-10
Business Address
Mr. DARIAN WADE LONG
925 HIGHWAY VV
KENNETT, MO 63857
Phone number: 573-888-5925
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Mailing Address
Mr. DARIAN WADE LONG
925 HIGHWAY VV
KENNETT, MO 63857-0071
Phone number:
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