| NPI | 1053534081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRASAD CHALASANI Officer 772-335-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 117-303-05-1010575) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2008-04-20 |