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1316425440
THEODORE DALLAS
SHREVEPORT, LA
NPI
1316425440
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2018-07-31
Last Update Date
2018-07-31
Business Address
THEODORE DALLAS
1543 GRIMMETT DR
SHREVEPORT, LA 71107-6505
Phone number: 318-626-5597
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Mailing Address
THEODORE DALLAS
1543 GRIMMETT DR
SHREVEPORT, LA 71107-6505
Phone number: 318-626-5597
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