| NPI | 1447606801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JACKSON Athletic Director 989-774-7657 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101018472) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-27 |