| NPI | 1508978933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE RUSHFORD SPOONER Owner/Operator 616-396-6635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 2301009161) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |