Louisiana
Board of Licensing
Green Tyson Ellis
Medical
License number
DPM.200024
Date expires
08/31/2015
Class
Medical
Status
Active
Address
1747 Imperial Blvd, Lake Charles, LA 70605
louisianalicensing.com
ID 21865392
LAST UPDATED 2024-03-18 13:39:19 UTC
LAST UPDATED 2024-03-18 13:39:19 UTC