| NPI | 1457741373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE A RASOR Office Manager 810-227-2767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 5101009380) |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2015-01-30 |