Individual
THOMAS ROYCE LACY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
(858) 987-2619
Mailing address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-7000
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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