Individual
LASONJIA DENISE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5202 MULBERRY PL, LITTLE ROCK, AR 72206-4913
(501) 772-6073
Mailing address
5202 MULBERRY PL, LITTLE ROCK, AR 72206-4913
(501) 240-8386
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
06/21/2019
Last updated
06/21/2019
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