| NPI | 1699407015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE WALLENS Accounting Manager 386-255-4568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2022-06-24 |