Individual
MR. JOSE LARA III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T
Contact information
Practice address
436 E BRADSTOCK WAY, SAN TAN VALLEY, AZ 85140-5773
(480) 244-5128
Mailing address
436 E BRADSTOCK WAY, SAN TAN VALLEY, AZ 85140-5773
(480) 244-5128
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT18417
AZ
Other
Enumeration date
10/24/2013
Last updated
10/24/2013
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