| NPI | 1568561207 |
|---|---|
| Doing Business As | LAKESIDE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | MARIA VAN DE BOVENKAMP Director Of Administration 910-790-9949 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-10-28 |