| NPI | 1205205481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERICA GIVANS Healthcare Administrator 313-421-9835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MI 632127) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2016-01-11 |