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1053761304
JESSE MAMON
RUSTON, LA
NPI
1053761304
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
172V00000X Community Health Worker
Enumeration Date
2016-06-17
Last Update Date
2016-06-17
Business Address
-- JESSE MAMON
2929 HIGHWAY 33
RUSTON, LA 71270-1628
Phone number: 318-251-9904
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Mailing Address
-- JESSE MAMON
2929 HIGHWAY 33
RUSTON, LA 71270-1628
Phone number: 318-251-9904
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