| NPI | 1114351152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA THELEN Director Of Operations 517-881-6051 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI AH370325563) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2015-03-09 |