| NPI | 1376812164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JAMES KIRBY II Administrator 989-430-8061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI AS180308851) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2011-12-22 |