| NPI | 1558804674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA ANNE NYBLADE Practice Administrator 231-740-0914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4704168366) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2017-01-19 |