| NPI | 1073051264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DEAN CHAFFEE Owner 231-796-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI am540070004) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2017-02-07 |