| NPI | 1205012523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD GERARD DESIRA Director 734-422-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 2301005025) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2008-01-16 |