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1811301617
JOHN CLARK
IDAHO FALLS, ID
NPI
1811301617
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
(Licence: ID LSW1381)
Enumeration Date
2014-06-19
Last Update Date
2014-06-19
Business Address
-- JOHN CLARK LSW
540 3RD ST
IDAHO FALLS, ID 83401-3953
Phone number: 208-524-5607
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Mailing Address
-- JOHN CLARK LSW
3791 E DEER CRK
IDAHO FALLS, ID 83401-6804
Phone number: 208-403-1327
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