| NPI | 1184111692 |
|---|---|
| Doing Business As | STATCLINIX - LAKESIDE |
| Entity Type | Organization |
| Authorized Contact | KIMBERLEE MILLER Medical Staff Coordinator 480-682-4118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-19 |