| NPI | 1255177598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVONA RENEE ANDERSON CEO 313-585-8659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2024-07-05 |
| Last Update Date | 2025-05-13 |