| NPI | 1447809041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBENEZER BALOGUN FAULKNER Managing Director 727-495-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2019-09-05 |