| NPI | 1215333596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JOSEPH FAREMOUTH Operating Member 313-505-5877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9581) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2014-11-17 |