| NPI | 1962088138 |
|---|---|
| Doing Business As | LAKE WALES DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | RAYMOND KNISLEY Owner 863-269-0790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2021-04-14 |