| NPI | 1104367242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CUCCINELLI Medical Director 810-309-9734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301111425) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |