| NPI | 1215131040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE HAIRSTON Medical Director And Owner 313-570-3521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 510102693) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2007-08-16 |