Organization
SOUTHSIDE PRIMARY CARE, INC.
Active
Other names
Southside Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEIGH A RAUBENOLT (CREDENTIALING)
(540) 371-4488
Entity
Organization
Contact information
Practice address
4103 LAFAYETTE BLVD, SUITE 2, FREDERICKSBURG, VA 22408-4274
(540) 891-5550
Mailing address
4103 LAFAYETTE BLVD, SUITE 2, FREDERICKSBURG, VA 22408-4274
(540) 891-5550
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0102037027
VA
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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