| NPI | 1487842696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEELA R BOLLA Owner 239-597-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL ME79879) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2008-07-28 |