| NPI | 1659997179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELVIN IVIA GAINES President 352-502-2938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2020-06-20 |