| NPI | 1225266075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA RENE GNAS Medical Director 586-697-2678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 5101013946) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2009-06-30 |