| NPI | 1508245408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE KOHN Cmo 231-737-1335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2018-02-13 |