Ursula Lori Clark

NPI #1710562129 in Lake Park, Georgia

Provider Information

NPI Number: 1710562129
Entity Type: Individual
Name: Ursula Lori Clark
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Contractor
Enumeration Date: Mar 17, 2021
Last Updated: Mar 17, 2021

Practice Location

Address: 4700 ROLLING PINE DR APT D25
City: Lake Park
State: Georgia
ZIP Code: 31636-4935
Phone: (305) 877-6401

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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