Individual
MR. FERNANDEZ A GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3610 LAKESIDE DR, SHREVEPORT, LA 71119-6516
(318) 560-3002
Mailing address
3610 LAKESIDE DR, SHREVEPORT, LA 71119-6516
(318) 560-3002
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/18/2016
Last updated
08/18/2016
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