JACK RUSSELLE LAKE

OKLAHOMA CITY, OK
NPI1932248101
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2085R0202X Radiology, Diagnostic Radiology
(Licence: OK  4205)
Enumeration Date2007-02-05
Last Update Date2011-01-26
Business Address
-- JACK RUSSELLE LAKE D.O.
940 NE 13TH ST 4G4250
OKLAHOMA CITY, OK 73104-5008
Phone number: 405-271-5125
Mailing Address
-- JACK RUSSELLE LAKE D.O.
940 NE 13TH ST 4G4250
OKLAHOMA CITY, OK 73104-5008
Phone number:
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