| NPI | 1265729883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN CODY State Medical Director 517-827-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 4301094288) |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2011-07-03 |