Individual
MRS. LACEY GREEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5419 HIGHWAY 25 STE R, FLOWOOD, MS 39232-6343
(601) 479-5392
Mailing address
5419 HIGHWAY 25 STE R, FLOWOOD, MS 39232-6343
(601) 479-5392
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1384
MS
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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