LARA DIANE CHURCH

PONTE VEDRA, FL
NPI1043280449
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: FL  ME105548)
Enumeration Date2006-01-26
Last Update Date2018-12-27
Business Address
Dr. LARA DIANE CHURCH M.D.
141 HILDEN RD STE 201 CREDENTIALING DEPARTMENT
PONTE VEDRA, FL 32081-8400
Phone number: 904-825-1941
Mailing Address
Dr. LARA DIANE CHURCH M.D.
PO BOX 45443
SALT LAKE CITY, UT 84145-0443
Phone number: 904-202-1032
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