Individual
MADISON JO LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 WELLS AVE E, SEBEKA, MN 56477-2730
(218) 639-3676
Mailing address
1001 WELLS AVE E, SEBEKA, MN 56477-2730
(218) 639-3676
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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