GARY BRADLEY LAKE

TUBA CITY, AZ
NPI1679518708
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: AZ  29509)
Enumeration Date2006-06-20
Last Update Date2007-07-08
Business Address
-- GARY BRADLEY LAKE MD
167 NORTH MAIN STREET
TUBA CITY, AZ 86045-0600
Phone number: 928-283-2501
Mailing Address
-- GARY BRADLEY LAKE MD
PO BOX 600 167 NORTH MAIN STREET
TUBA CITY, AZ 86045-0600
Phone number: 928-283-2501
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