| NPI | 1629467725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA G PROCHAZKA Owner 734-776-0676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801005822) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2015-01-13 |