| NPI | 1760881163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVI K KANCHA Docto 904-400-6800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: FL ME98044) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-11-12 |