| NPI | 1265837280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA R BALLEZA Medical Director 313-368-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: MI 4301049546) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone (Licence: MI SA0822928) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2016-02-11 |