| NPI | 1720572407 |
|---|---|
| Doing Business As | LAKESIDE PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | AIMEE KILGO President 256-266-1544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2022-12-09 |