| NPI | 1487189437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN KOCIS MOLZON Executive Director 810-344-6860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |