Individual
URSULA LORI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4700 ROLLING PINE DR APT D25, LAKE PARK, GA 31636-4935
(305) 877-6401
Mailing address
4700 ROLLING PINE DR APT D25, LAKE PARK, GA 31636-4935
(305) 877-6401
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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