| NPI | 1073188736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN FULFORD BROX CEO 248-309-3795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 251V00000X Voluntary or Charitable | |
| 333600000X Pharmacy | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |