| NPI | 1760676795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE A ROTH Owner 231-935-0848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301046406) |
| Enumeration Date | 2007-09-03 |
| Last Update Date | 2013-08-16 |