Individual
MR. SANTAGO CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4607 TRIAL DR., ADDIS, LA 70710
(225) 907-6659
Mailing address
4607 TRIAL DR., ADDIS, LA 70710
(225) 907-6659
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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