| NPI | 1497128649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES F ROOST Resident Agent 517-321-3030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 2301004303) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2023-09-14 |