| NPI | 1407135452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMAR A GHOSN Clinical Director 313-903-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI 5501015581) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2011-08-09 |