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1528037793
JACK LANE
LEMOORE, CA
NPI
1528037793
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: CA 20A6726)
Enumeration Date
2006-03-17
Last Update Date
2007-07-08
Business Address
-- JACK LANE DO
937 FRANKLIN AVE
LEMOORE, CA 93246-0001
Phone number: 559-998-4262
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Mailing Address
-- JACK LANE DO
1262 WHEELER CT
TULARE, CA 93274-0962
Phone number:
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