Individual
MR. LORENZO SOUTHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.S.
Contact information
Practice address
555 SCHILLER ST., #20, SUN PRAIRIE, WI 53590-2995
(608) 341-8249
Mailing address
555 SCHILLER ST., #20, SUN PRAIRIE, WI 53590-2995
(608) 341-8249
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/11/2010
Last updated
12/03/2014
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