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1942596515
DEANDRE LAVELL TAYBORE
BENTON, AR
NPI
1942596515
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2011-06-22
Last Update Date
2013-04-22
Business Address
Mr. DEANDRE LAVELL TAYBORE
718 ALCOA RD
BENTON, AR 72015-3406
Phone number: 501-776-4110
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Mailing Address
Mr. DEANDRE LAVELL TAYBORE
PO BOX 1589
BENTON, AR 72018-1589
Phone number: 501-776-4110
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