Organization
VA DIABETIC FOOT SOURCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR V MANNING RN (OWNER)
(318) 560-2700
Entity
Organization
Contact information
Practice address
9414 ASHMONT ST, SHREVEPORT, LA 71129-4830
(318) 560-2700
Mailing address
9414 ASHMONT ST, SHREVEPORT, LA 71129-4830
(318) 560-2700
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
RN121799
LA
Other
Enumeration date
03/10/2010
Last updated
03/10/2010
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