| NPI | 1750849022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY WESSELS Bemefits/Credentialing Coordinator 734-545-6335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2019-03-06 |