Individual
LARONDA LASHA MANUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2240 TV RD APT 4B, JACKSON, MS 39209-3586
(601) 906-6961
Mailing address
2240 TV RD APT 4B, JACKSON, MS 39209-3586
(601) 906-6961
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
800934113
MS
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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