| NPI | 1063448629 |
|---|---|
| Doing Business As | SOUTHGLEN FAMILY PRACTICE & UC |
| Entity Type | Organization |
| Authorized Contact | ERICK J LAINE COO 515-471-9227 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: IA 1100240056) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2012-08-16 |