| NPI | 1487252458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ERIC ROBERTS Provider 989-708-9074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2023-02-17 |