| NPI | 1891154498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVIENDER BUKKAPATNAM Physician 813-258-9565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME90062) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2016-02-11 |