| NPI | 1083417844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BALLARD Co Owner, Manager 734-913-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-28 |