ERICHSEN R BONOSTRO

LAKELAND, FL
NPI1902170327
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AS0400X Physician Assistant, Surgical
(Licence: FL  PA9106442)
Additional Taxonomies363AM0700X Physician Assistant, Medical
(Licence: FL  PA9106442)
Enumeration Date2012-03-02
Last Update Date2017-07-07
Business Address
-- ERICHSEN R BONOSTRO PAC
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805-4543
Phone number: 863-687-1321
Mailing Address
-- ERICHSEN R BONOSTRO PAC
1324 LAKELAND HILLS BLVD ATTN: MANAGED CARE DEPT.
LAKELAND, FL 33805
Phone number: