| NPI | 1548663107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALYNN POTTER Self Employed 248-563-1743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6401011359) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |