| NPI | 1578572939 |
|---|---|
| Doing Business As | LAKE PARK FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | DANIEL L WIENS Senior Vice President 704-355-0648 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-06-28 |