Individual
MRS. TAMARA GRIGALTCHIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12105 MADRID AVE, NORTH PORT, FL 34287-1123
(941) 423-0019
(941) 423-0019
Mailing address
12105 MADRID AVE, NORTH PORT, FL 34287-1123
(941) 423-0019
(941) 423-0019
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
6906380
FL
Other
Enumeration date
12/29/2009
Last updated
12/29/2009
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