Individual
MELVYN JUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3058 GORDONIA DR, SHREVEPORT, LA 71107-5848
(318) 519-8736
Mailing address
3058 GORDONIA DR, SHREVEPORT, LA 71107-5848
(318) 519-8736
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
009575064
LA
Other
Enumeration date
02/20/2020
Last updated
02/20/2020
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