| NPI | 1134679491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE MURRY Administrative Assistant 5177-840-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MI 4704230899) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |