| NPI | 1780652693 |
|---|---|
| Doing Business As | LAKE JEANETTE URGENT CARE, PLLC |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY M BOAZE Organizing Member/Owner 336-601-0812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2011-11-17 |