| NPI | 1609810985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD EZRA RUTHERFORD Owner President 616-844-4067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101009705) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2011-10-04 |