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Individual

KIRA RACINE GROVES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
2750 ASTER ST, LAKE CHARLES, LA 70601-8824
(337) 480-8900
(337) 480-8901
Mailing address
PO BOX 122539 DEPT 2539, DALLAS, TX 75312-0001
(337) 494-2921
(337) 494-6523

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
324736
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2540866
LA
01
324736
STATE LICENSE
LA
Enumeration date
04/02/2017
Last updated
04/27/2022
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