| NPI | 1962791509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANNE L DUFORT Billing/Credentialing Agent 231-775-0374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: MI 4301407392) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2011-04-27 |