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1144849589
LARRY DALE CLARK
ROSEBURG, OR
NPI
1144849589
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2020-04-15
Last Update Date
2020-04-15
Business Address
LARRY DALE CLARK
621 W MADRONE ST
ROSEBURG, OR 97470-3090
Phone number: 541-440-3532
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Mailing Address
LARRY DALE CLARK
621 W MADRONE ST
ROSEBURG, OR 97470-3090
Phone number: 541-440-3532
Copy
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