| NPI | 1588114094 |
|---|---|
| Doing Business As | WELLSPAN FAMILY MEDICINE - LAKE STREET |
| Entity Type | Organization |
| Authorized Contact | CHRISTINA MOON Supervisor Verification Services 717-851-1405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2016-10-07 |