NPI | 1447689302 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE LEE DAILL Physician/Owner 734-823-5437 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 4704269680) |
Enumeration Date | 2013-11-01 |
Last Update Date | 2013-11-01 |