Individual
MARY LISA LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5670 NYS ROUTE 86, WILMINGTON, NY 12997-2015
(518) 637-2306
Mailing address
5670 NYS ROUTE 86, WILMINGTON, NY 12997-2015
(518) 637-2306
Taxonomy
Speciality
Code
Description
License number
State
344600000X
Taxi
Primary
498510286
NY
Other
Enumeration date
02/27/2012
Last updated
02/27/2012
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