Individual
LE TRAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4358 BURNS RD NW, LILBURN, GA 30047-3596
(770) 564-8023
Mailing address
3824 SAFEHAVEN CT, LAWRENCEVILLE, GA 30044-4057
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
029211
GA
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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