| NPI | 1679804058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA JAKSIC Manager 906-228-3655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: MI 4704142802) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2010-01-25 |