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1487969168
CRYSTAL R ELLIS
MONROE, LA
NPI
1487969168
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
174400000X Specialist
(Licence: LA Z12381)
Enumeration Date
2010-08-18
Last Update Date
2010-08-18
Business Address
-- CRYSTAL R ELLIS OT
1828 TOWER DR
MONROE, LA 71201-4938
Phone number: 318-338-2081
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Mailing Address
-- CRYSTAL R ELLIS OT
109 CASTOR CV
CALHOUN, LA 71225-9301
Phone number: 318-644-2797
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