| NPI | 1407034127 |
|---|---|
| Doing Business As | BETWEEN THE LAKES PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | MATTHEW G HEDTKE Executive Director 864-885-7673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: SC 261QR1300X) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2008-02-05 |