| NPI | 1194376566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MCQUEEN Revenue Cycle Manager/Credentialing 248-724-7413 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2019-09-30 |