| NPI | 1063788651 |
|---|---|
| Doing Business As | OTHER FQHC PPS SERVICES |
| Entity Type | Organization |
| Authorized Contact | JOSEPH W FERGUSON Executive Director 313-416-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2012-03-28 |