| NPI | 1154386563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN SAN TOS Administrator 248-552-0283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 236789) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2007-09-24 |