Individual
LAURIE DE ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
851 YELLOWJACKET LN, CLINTON, AR 72031-6873
(501) 745-6034
Mailing address
1840 COLUMBIA DR, CONWAY, AR 72034-7392
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OTR1268
AR
Other
Enumeration date
01/03/2007
Last updated
07/09/2007
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