Individual
LEATHRICE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
709 EAST JEFFERSON ST, VILLE PLATTE, LA 70586
(337) 336-0341
Mailing address
709 E JEFFERSON ST, VILLE PLATTE, LA 70586-3911
(337) 336-0341
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
555855
LA
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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