| NPI | 1174711105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY JASON BORCK President 517-448-2277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI 2301008759) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2007-10-03 |