| NPI | 1104435460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYMALETHA BROWN Coordinator 269-414-5907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2022-01-20 |