| NPI | 1235588716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CARSON Physician 239-348-5871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MI 5101007330) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-06-06 |