Individual
ANITA LASHERYL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 BANKSIDE DR, CANTON, MS 39046-5039
(314) 456-9566
(601) 790-9759
Mailing address
108 BANKSIDE DR, CANTON, MS 39046-5039
(314) 456-9566
(601) 790-9759
Taxonomy
Speciality
Code
Description
License number
State
171WV0202X
Vehicle Modifications Contractor
Primary
—
MS
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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