| NPI | 1871641209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUMARAN KONDATH MOHAN Direct Owner 352-589-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 83819) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-10-26 |