JACK LANE

LEWISTON, ID
NPI1275902520
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy314000000X Skilled Nursing Facility
(Licence: ID  PTA-3672)
Enumeration Date2015-09-16
Last Update Date2015-09-16
Business Address
Mr. JACK LANE PTA
615 29TH ST
LEWISTON, ID 83501-3341
Phone number: 208-985-4722
Mailing Address
Mr. JACK LANE PTA
615 29TH ST
LEWISTON, ID 83501-3341
Phone number: 208-985-4722
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