| NPI | 1225507692 |
|---|---|
| Doing Business As | PHC OF AL LAKESHORE |
| Entity Type | Organization |
| Authorized Contact | DAVID A. CULVER Administrator 904-825-4368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2018-11-15 |