| NPI | 1699328146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA INGLIS WOLLAM Clinical Administrator 231-252-1228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2021-12-09 |