Organization
HEALTHSOURCE OF LAKE BOONE TRAIL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA C EVANS (BILLING MANAGER)
(919) 585-7365
Entity
Organization
Contact information
Practice address
4025 LAKE BOONE TRL, SUITE 120, RALEIGH, NC 27607-2986
(919) 785-9191
(919) 785-9193
Mailing address
4025 LAKE BOONE TRAIL, SUITE 120, RALEIGH, NC 27607-2986
(910) 431-4330
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3364
NC
Other
Enumeration date
10/18/2011
Last updated
11/10/2011
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