| NPI | 1073940789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA JOYCE AALTO Owner 906-748-0060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 6801091424) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2013-09-26 |