| NPI | 1457635815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK SIMON Director Of Operations 229-809-0403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-04 |