| NPI | 1376599472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIDYASAGAR REDDY VANGALA Manager Member 863-419-7645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: FL ME82811) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2010-11-22 |