| NPI | 1407208671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA VICTORIA DEMONTEGNAC Owner/Clinical Director 269-240-4631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 74368) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-07-12 |