| NPI | 1851865638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLA JANE PENNINGTON Office Manager 231-347-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2024-02-29 |