| NPI | 1235194861 |
|---|---|
| Doing Business As | LAKE PRIME CARE |
| Entity Type | Organization |
| Authorized Contact | WEENA C FAVIS Owner 352-365-1224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 203BI03004) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2016-03-15 |