Individual
LAQUESA SHANTEL FOSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121 HILLWOOD DR, HENDERSONVILLE, TN 37075-2221
(615) 818-3074
(615) 431-0631
Mailing address
PO BOX 2143, HENDERSONVILLE, TN 37077-2143
(615) 818-3074
(615) 431-0631
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
007326
TN
Other
Enumeration date
05/20/2013
Last updated
05/20/2013
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