| NPI | 1396987426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEYANNE ELIZABETH BOSS Office Manager 616-916-7429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI BK007987) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2025-09-03 |