| NPI | 1538481072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE SUSAN MARTIN Operations Manager 906-225-0848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI al520007247) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |