Individual
DEMONTRELL ONEIL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4712 ARNSDALE CIR, SHREVEPORT, LA 71109-6202
(318) 286-1338
Mailing address
4712 ARNSDALE CIR, SHREVEPORT, LA 71109-6202
(318) 286-1338
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
010250952
LA
Other
Enumeration date
04/27/2021
Last updated
04/27/2021
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