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1114491685
MALLORY MANCUSO
LAFAYETTE, LA
NPI
1114491685
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2019-01-17
Last Update Date
2019-01-17
Business Address
MALLORY MANCUSO
110 LANA DR
LAFAYETTE, LA 70503-4505
Phone number: 504-312-0218
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Mailing Address
MALLORY MANCUSO
110 LANA DR
LAFAYETTE, LA 70503-4505
Phone number:
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