NPI | 1144782632 |
---|---|
Doing Business As | LAKESIDE FAMILY MEDICINE |
Entity Type | Organization |
Authorized Contact | BRENDA LARIE SOUTHERLAND CFO 501-625-7500 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Enumeration Date | 2019-04-03 |
Last Update Date | 2019-04-03 |