| NPI | 1841541307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DE METRIA M CLARK Care Management Coordinator 616-391-3759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: MI 15206) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |