| NPI | 1134310022 |
|---|---|
| Former Legal Business Name | LAKE COUNTRY UROLOGY CLINIC |
| Entity Type | Organization |
| Authorized Contact | MARIANO ORCA Md 269-651-4708 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2007-08-06 |