| NPI | 1093169823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA JACKSON Developmental Interventionist 270-847-7004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2016-04-18 |