PROVIDER SERVICE ORGANIZATION

CANTON, MI
NPI1447610704
Entity TypeOrganization
Authorized ContactRAMON VILLANUEVA
President
734-516-4239
Organization Subpart ?No
Primary Taxonomy207QG0300X Family Medicine Geriatric Medicine
Enumeration Date2016-02-29
Last Update Date2016-06-06
Business Address
PROVIDER SERVICE ORGANIZATION
7233 PROVINCIAL CT
CANTON, MI 48187-2121
Phone number: 734-516-4239
Mailing Address
PROVIDER SERVICE ORGANIZATION
7233 PROVINCIAL CT
CANTON, MI 48187-2121
Phone number: 734-516-4239
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