| NPI | 1467880682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWANDY BOLIS Physician 352-796-5102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME102757) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3351) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2013-10-25 |