| NPI | 1841315090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN P MARCONNIT President 989-786-2104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 292200000X Dental Laboratory (Licence: MI 13005) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-09-11 |