| NPI | 1114431319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLOR GURGANUS Owner 252-340-1395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2022-01-03 |