| NPI | 1134586704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA NICOLE HOOPER Owner 313-499-8117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 251X00000X |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2016-01-26 |