Individual
LACEY RAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 S BROAD ST, SUITE A, GROVE CITY, PA 16127-1544
(724) 458-1500
(724) 458-1501
Mailing address
120 S BROAD ST, SUITE A, GROVE CITY, PA 16127-1544
(724) 458-1500
(724) 458-1501
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OC014811
PA
Other
Enumeration date
08/04/2016
Last updated
11/08/2016
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