Individual
LACEY DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
221 MAIN ST., AUGUSTA, KY 41002
(606) 402-1354
Mailing address
221 MAIN ST., AUGUSTA, KY 41002
(606) 402-1354
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
204297
KY
Other
Enumeration date
09/10/2018
Last updated
09/10/2018
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