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Individual

MICHAEL MILES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
216 DEER TRAIL DR, BENTON, LA 71006-4414
(318) 469-3301
Mailing address
216 DEER TRAIL DR, BENTON, LA 71006-4414
(318) 469-3301

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
006420963
LA

Other

Enumeration date
04/28/2021
Last updated
04/28/2021
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