| NPI | 1174866610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN LEWIS Owner 810-820-7279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI AS250337649) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2013-04-03 |