| NPI | 1629687736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORREY ESALOMI Owner/Operator 813-352-5293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2020-07-24 |