Individual
TOM LYLE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
400 W ELM AVE, FLAGSTAFF HIGH SCHOOL, FLAGSTAFF, AZ 86001-1562
(928) 527-1531
(928) 773-8146
Mailing address
3464 NE RAINIER LOOP, FLAGSTAFF, AZ 86004-1747
(928) 527-1531
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0036
AZ
Other
Enumeration date
02/22/2006
Last updated
07/08/2007
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