Organization
VEIN CARE PAVILION OF THE SOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI DAVIS (MANAGING MEMBER)
(706) 951-1998
Entity
Organization
Contact information
Practice address
W178N9912 RIVERCREST DR, SUITE 102, GERMANTOWN, WI 53022-4645
(262) 672-6900
Mailing address
W178N9912 RIVERCREST DR, SUITE 102, GERMANTOWN, WI 53022-4645
(262) 672-6900
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
44670-20
WI
Other
Enumeration date
02/04/2013
Last updated
07/16/2013
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