| NPI | 1285822981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMMI K BALI President 386-755-1703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: FL BB6375477) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2013-09-30 |