# 3XS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST MINA PRIMARY CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093057986
- **Authorized official:** DR. LAWANDY FAWZY BOLIS M.D. (OWNER)
- **Authorized official phone:** (352) 796-5102

## Contact information

- **Practice address:** 17222 HOSPITAL BLVD, SUITE 242, BROOKSVILLE, FL 34601-8925
- **Practice address phone:** (352) 796-5102
- **Practice address fax:** (352) 796-2144
- **Mailing address:** 14391 SPRING HILL DR, SUITE 444, SPRING HILL, FL 34609-8199
- **Mailing address phone:** (352) 796-5102
- **Mailing address fax:** (352) 796-2144

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2013
- **Last updated:** 03/19/2013