Desirae Clark
NPI #1477100717 in Kansas City, Missouri
Provider Information
- NPI Number
- 1477100717
- Entity Type
- Individual
- Name
- Desirae Clark
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Prosthetic/Orthotic Supplier
- Enumeration Date
- Aug 21, 2019
- Last Updated
- Aug 21, 2019
Practice Location
- Address
- 5100 LYDIA AVE
- City
- Kansas City
- State
- Missouri
- ZIP Code
- 64110-2608
- Phone
- (826) 749-9147
Specialties & Taxonomy Codes
| Specialty |
|---|
| Prosthetic/Orthotic Supplier |
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