| NPI | 1306922968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYME S THOMPSON Program Support Assistant 734-845-3007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: MI 4301036985) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2023-03-07 |