Individual
LARRY D ELLIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2215 STEEP PINE TRL, FRESNO, TX 77545-8831
(832) 362-1350
Mailing address
2215 STEEP PINE TRL, FRESNO, TX 77545-8831
(832) 362-1350
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/07/2015
Last updated
02/07/2015
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