| NPI | 1548994064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOUROU VALERY WILSON PLAGBETO Co Owner 347-375-5728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-07-11 |