| NPI | 1235538828 |
|---|---|
| Doing Business As | LAKESIDE FAMILY MEDICINE ANDOVER |
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-964-1506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: OH 34.004448) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2014-08-19 |