Organization
UNDERGROUND FITNESS 2, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN BERGERON (MANAGING MEMBER)
(407) 463-6940
Entity
Organization
Contact information
Practice address
1137 LAKE UNDERHILL ROAD, SUITE 600, ORLANDO, FL 32825
(407) 463-6940
Mailing address
PO BOX 7811973, ORLANDO, FL 32878-1973
(407) 463-6940
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
04/03/2013
Last updated
04/03/2013
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