| NPI | 1053676353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGHAN ELIZABETH RILEY Owner 248-254-2838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI r400599210232) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |