Individual
LAURA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
283 WINSLOW WAY, BETHLEHEM, GA 30620-3248
(678) 361-1117
Mailing address
283 WINSLOW WAY, BETHLEHEM, GA 30620-3248
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
37433
GA
Other
Enumeration date
08/13/2009
Last updated
08/13/2009
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