| NPI | 1861706434 |
|---|---|
| Doing Business As | STOCKTON LAKE WALKIN CLINIC |
| Entity Type | Organization |
| Authorized Contact | DAVID E SMOCK Owner 928-503-4261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MO 2003017056) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2015-01-29 |