| NPI | 1093057986 |
|---|---|
| Doing Business As | ST MINA PRIMARY CLINIC |
| Entity Type | Organization |
| Authorized Contact | LAWANDY FAWZY BOLIS Owner 352-796-5102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2013-03-19 |