| NPI | 1073856704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN D RUSSELL Executive Director 313-228-0930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 4301079196) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2015-11-02 |