| NPI | 1306303235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANISHA JEREMEKA CARODINE Owner 904-707-7280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2019-02-27 |