JUSTIN JEFFEREY LAKE

DAYTON, OH
NPI1710410998
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207P00000X Emergency Medicine
(Licence: OH  34.013545)
Enumeration Date2017-04-05
Last Update Date2020-07-27
Business Address
JUSTIN JEFFEREY LAKE
405 W GRAND AVE
DAYTON, OH 45405-7538
Phone number: 937-723-3245
Mailing Address
JUSTIN JEFFEREY LAKE
3131 NEWMARK DR STE 210
MIAMISBURG, OH 45342-5400
Phone number: 937-438-8910
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