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1275277733
BLAINE BULLOCH
SHREVEPORT, LA
NPI
1275277733
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2022-04-21
Last Update Date
2022-04-21
Business Address
BLAINE BULLOCH
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-626-2127
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Mailing Address
BLAINE BULLOCH
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number:
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