| NPI | 1649733148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA JANE PENNINGTON Assistant 231-347-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2021-01-21 |