| NPI | 1396122818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCILA RYDER Program Director 313-493-4410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 164W00000X) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2015-05-05 |