| NPI | 1811576119 |
|---|---|
| Doing Business As | IDDSS |
| Entity Type | Organization |
| Authorized Contact | MILDRED TEMBUNDE Credentialing 571-337-5732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2021-04-05 |