Individual
KELVIN MALONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1610 SHIVELY RD, SALINE, LA 71070-2355
(318) 583-2892
Mailing address
1610 SHIVELY RD, SALINE, LA 71070-2355
(318) 583-2892
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
005199747
LA
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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