| NPI | 1770819344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARJORIE M RENFROW Owner 989-980-1587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301079633) |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2009-11-02 |