| NPI | 1124289806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEETHAYE L ITTIARA Owner 517-263-5810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI TI031889) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2008-06-24 |