| NPI | 1669619441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DAVID RICHARDSON Owner 269-781-3938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301047635) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2010-06-10 |