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1407318413
LANE FONTENOT
SHREVEPORT, LA
NPI
1407318413
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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
2019-04-01
Last Update Date
2019-04-01
Business Address
LANE FONTENOT
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-795-2638
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Mailing Address
LANE FONTENOT
1501 KINGS HWY
SHREVEPORT, LA 71103-4228
Phone number: 318-795-2638
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