| NPI | 1275969990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: MI 580077) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone (Licence: MI 823074) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2013-09-26 |