| NPI | 1326649120 |
|---|---|
| Other Name | SOURCE MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | THOMAS HENKE Owner/Physician 616-916-8063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2022-01-23 |