Organization
MAIN STREET MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. OMOSALEWA OGUNDIPE (DIRECTOR)
(813) 413-8258
Entity
Organization
Contact information
Practice address
10802 E. MAIN ST, STE B, THONOTOSASSA, FL 33592-2840
(813) 413-8258
(813) 413-8310
Mailing address
10802 E. MAIN STREET,, STE. B, THONOTOSSASSA, FL 33592
(813) 413-8258
(813) 413-8310
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME88205
FL
Other
Enumeration date
01/13/2010
Last updated
01/13/2010
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