| NPI | 1205090354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY L. JACKSON-HAMMOND Medical Director 313-831-8805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 4301046737) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2008-07-17 |