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1053041830
LISA JACK
WICHITA, KS
NPI
1053041830
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
174400000X Specialist
Enumeration Date
2022-06-14
Last Update Date
2022-06-14
Business Address
LISA JACK
8625 E 37TH ST N STE 101
WICHITA, KS 67226-2008
Phone number: 316-648-8545
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Mailing Address
LISA JACK
5709 E 17TH ST N
WICHITA, KS 67208-1703
Phone number: 316-648-8545
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