| NPI | 1801575972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY LATIBEAUDIER Co Director 260-280-3341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-14 |