| NPI | 1134569874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA JEAN MARTINES Targeted Case Manager 810-496-4857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI 6802086448) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2013-06-26 |