| NPI | 1902333263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA IRENE KAZEMIER Executive Director 231-250-9193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI M730256) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2022-07-21 |