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1386141539
STEPHEN DANIEL SLACK
SHREVEPORT, LA
NPI
1386141539
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171W00000X Contractor
Enumeration Date
2018-04-12
Last Update Date
2018-04-12
Business Address
STEPHEN DANIEL SLACK
458 W 61ST ST
SHREVEPORT, LA 71106-2511
Phone number: 318-510-1141
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Mailing Address
STEPHEN DANIEL SLACK
458 W 61ST ST
SHREVEPORT, LA 71106-2511
Phone number: 318-510-1141
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