| NPI | 1336927870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEVELLE R JORDAN Owner 727-674-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2024-05-06 |