Individual
KATINA LACHELLA LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2837 MOORE RD, RED BANKS, MS 38661-9652
(901) 827-5581
Mailing address
2837 MOORE RD, RED BANKS, MS 38661-9652
(901) 827-5581
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
801684845
MS
Other
Enumeration date
09/26/2018
Last updated
09/26/2018
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