Individual
MR. CHARLES HARROLD I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2800 YOUREE DR STE 304, SHREVEPORT, LA 71104-3660
(318) 210-1967
Mailing address
PO BOX 4532, SHREVEPORT, LA 71134-0532
(318) 210-1967
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
00269798
LA
Other
Enumeration date
05/21/2014
Last updated
05/21/2014
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