| NPI | 1215671086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA BAKER Administrator 248-667-8977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 261QP3300X Clinic/Center Pain |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-04-26 |