Individual
LACEY JO LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2114 PINEFIELD ST, MUSCATINE, IA 52761-2553
(563) 607-2372
Mailing address
2114 PINEFIELD ST, MUSCATINE, IA 52761-2553
(563) 607-2372
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
11471
IA
Other
Enumeration date
06/18/2014
Last updated
06/18/2014
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