Individual
CLINT JASON DESOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
461 AIRBASE RD, POLLOCK, LA 71467-3549
(318) 715-1792
(318) 765-7641
Mailing address
461 AIRBASE RD, POLLOCK, LA 71467-3549
(318) 715-1792
(318) 765-7641
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
89464
LA
Other
Enumeration date
12/17/2008
Last updated
12/17/2008
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