| NPI | 1962625822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA K STANLEY Sole Proprietor 269-684-8100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301043549) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |