| NPI | 1073283347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE WALLENS Accounting Manager 386-255-4568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2021-09-17 |