| NPI | 1215116967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK PETROUS Owner 248-442-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MI mp056981) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |