Organization
LAKESIDE FAMILY CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH ABIGAIL MOSS D.O. (DOCTOR)
(817) 573-8320
Entity
Organization
Contact information
Practice address
900 WHITEHEAD DR., GRANBURY, TX 76048
(817) 573-8320
(817) 573-8294
Mailing address
PO BOX 2249, GRANBURY, TX 76048-7249
(817) 573-8320
(817) 573-8294
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
J6020
TX
Other
Enumeration date
02/27/2008
Last updated
02/27/2008
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