| NPI | 1215125919 |
|---|---|
| Doing Business As | PINE LAKE FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | DANIEL L. WIENS Senior Vice President Of Operations 704-355-0648 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2010-12-22 |