| NPI | 1316295140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN GARFIELD SANDERSON President 906-249-5630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI SS007777) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2012-09-13 |