| NPI | 1609046184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKIE BENNETT Owner 616-942-2966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 5101012967) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MI 5101012967) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2012-08-06 |