| NPI | 1346414620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ANTHONY MALEC President Of Corporation 616-459-3564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 4301026401) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-08-28 |