| NPI | 1003396862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA LASHELL TINNEY Owner 904-365-9123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2018-08-20 |