Individual
LAQUINTA HALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
449 TRINITY AVE, PORT ARTHUR, TX 77642-1335
(409) 982-1154
Mailing address
PO BOX 46, PORT ARTHUR, TX 77641-0046
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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