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1225703853
TRESTON GRANT CLARK-LARUE
LILLINGTON, NC
NPI
1225703853
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
Enumeration Date
2021-08-16
Last Update Date
2021-08-16
Business Address
TRESTON GRANT CLARK-LARUE PA-C
4350 US 421 S
LILLINGTON, NC 27546-6760
Phone number: 910-893-1210
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Mailing Address
TRESTON GRANT CLARK-LARUE PA-C
142 WESTWICK LN APT 19
FAYETTEVILLE, NC 28314-2732
Phone number: 814-241-3992
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