| NPI | 1235434614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS WALKER Owner/Operator 586-783-7153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI 6801034348) |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2015-07-23 |