| NPI | 1295016103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLETA POYDRAS Physician Assistant 313-515-7828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MI 363A50400X) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |