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1598289274
LUCAS ALEXANDER BRYAN
POCATELLO, ID
NPI
1598289274
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
Enumeration Date
2017-08-03
Last Update Date
2019-07-25
Business Address
LUCAS ALEXANDER BRYAN
1535 E TERRY ST
POCATELLO, ID 83201
Phone number: 208-881-4385
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Mailing Address
LUCAS ALEXANDER BRYAN
PO BOX 545
IONA, ID 83427-0545
Phone number: 208-529-3096
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