| NPI | 1245897503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY WALTON Owner 313-468-2842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2024-01-04 |