| NPI | 1235325226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA LERTOLA Manager 586-754-3830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI mk058470) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2010-07-14 |