| NPI | 1558652586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYANTH BOLARAM D Irector 863-214-3230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME92560) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2015-01-05 |