| NPI | 1205980232 |
|---|---|
| Doing Business As | SOUTH SIDE MED EX |
| Entity Type | Organization |
| Authorized Contact | VICKIE KHANNA Secretary 817-923-1953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2013-10-10 |