| NPI | 1104922863 |
|---|---|
| Doing Business As | WATTLES PARK FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | BARB C VANHAITSMA Practice Manager 269-969-4656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301083010) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2008-01-09 |