| NPI | 1922581586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVIDSON ANTOINE President 754-214-9628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2018-09-11 |