| NPI | 1710209101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRIE ANN LAHTI Owner/ Primary Care Provider 906-249-8916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI AF520238291) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2010-02-25 |