| NPI | 1790096931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEDDY B BRANDON Executive Director 269-668-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0904X Clinic/Center, Public Health, Federal (Licence: IN 31001489A) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MI 5201001223) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2010-06-22 |