| NPI | 1699310649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LOHMAN Regional Director 231-672-2156 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2019-11-14 |