| NPI | 1265834949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGHA J FORD Owner 313-969-8975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4704244847) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2014-09-24 |