| NPI | 1497290456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE PEARL Nurse Practitioner 313-570-7906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 4704208352) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2016-12-30 |