| NPI | 1225218738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELISA BARGAINER Billing Manager 313-920-2666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI AM069572) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |