| NPI | 1053869487 |
|---|---|
| Doing Business As | LAKE REGIONAL PRIMARY CARE |
| Entity Type | Organization |
| Authorized Contact | GLENDA MARTI Billing Manager 352-315-1651 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: FL ME77919) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-10-11 |