| NPI | 1104342054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL WIMES-ANDERSON Owner 904-554-4620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2022-07-21 |