| NPI | 1255736203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAHKETA REN'E FLETCHER Owner 313-424-2504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI E4877Y) |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2014-11-01 |