| NPI | 1013350404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARAE JACKSON Office Manager 734-454-5454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2013-04-16 |