| NPI | 1962701722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARISA MALYKH Practice Owner/Physician 386-329-3939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2012-03-26 |