| NPI | 1164168126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY L LONG Associate Medical Director 734-341-7767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-06-23 |