| NPI | 1962044602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HESLUNE LORRAINE BOATWRIGHT Owner 863-232-8486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2019-10-15 |