Individual
LAGRAND ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
107 MEADOW POINTE CV, BRANDON, MS 39042-5014
(601) 720-1409
Mailing address
107 MEADOW POINTE CV, BRANDON, MS 39042-5014
(601) 720-1409
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
02/26/2015
Last updated
05/06/2015
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