| NPI | 1407412810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE BURHANS Director Of Business Operations 734-216-4396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2022-05-19 |