| NPI | 1922604982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY MAIA WHITAKER Owner/Provider 813-863-7570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |