BLAINE BULLOCH

SHREVEPORT, LA
NPI1275277733
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2022-04-21
Last Update Date2022-04-21
Business Address
BLAINE BULLOCH
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-626-2127
Mailing Address
BLAINE BULLOCH
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number:
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