| NPI | 1710404249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE TIBAUD Owner 407-779-6708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-07-21 |