| NPI | 1861689416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GALE ANN BRISTOL Owner 616-459-5712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801059875) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2007-09-27 |