| NPI | 1750448163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAG RAVICHANDRAN Administrator 904-389-3770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine Geriatric Medicine (Licence: FL ME741014) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-02-06 |