| NPI | 1154835064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARVARES JERMAINE DOWNING Owner 863-242-3621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2018-02-08 |