| NPI | 1619413929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN SHEDD KELLY-WEBER Clinical Supervisor 517-745-0384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MI 6801067359) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2017-01-10 |