| NPI | 1619257961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KUCHAKULLA N REDDY Treasurer 352-732-9844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2016-05-05 |