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 |