| NPI | 1417257189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACHELLE DIA VIETZ Director 269-998-4388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI D4854G) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2010-10-28 |