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1154058162
KENNETH LEE JACKSON
LAKE CHARLES, LA
NPI
1154058162
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
343900000X Non-emergency Medical Transport (VAN)
Enumeration Date
2022-08-01
Last Update Date
2022-08-01
Business Address
Mr. KENNETH LEE JACKSON
1216 OKLAHOMA ST
LAKE CHARLES, LA 70607-3624
Phone number: 337-414-0914
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Mailing Address
Mr. KENNETH LEE JACKSON
1216 OKLAHOMA ST
LAKE CHARLES, LA 70607-3624
Phone number: 337-414-0914
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