| NPI | 1265875892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M LUCAS Practitioner 800-363-4661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: MI 4704237090) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2013-04-25 |