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 |