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1265108260
JUSTIN T TANNER
MANDEVILLE, LA
NPI
1265108260
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
Enumeration Date
2021-08-19
Last Update Date
2021-08-19
Business Address
JUSTIN T TANNER PSS
900 WILKINSON ST
MANDEVILLE, LA 70448-3533
Phone number: 985-624-4450
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Mailing Address
JUSTIN T TANNER PSS
900 WILKINSON ST
MANDEVILLE, LA 70448-3533
Phone number: 985-624-4450
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