| NPI | 1780700765 |
|---|---|
| Other Name | SOUTHSIDE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | SHIRLENE TOLBERT MOTEN Medical Director 804-733-3739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101054986) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-11-16 |