| NPI | 1952098204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARIEL TANEE WILLIAMSON Owner 904-600-8207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |