| NPI | 1497294805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL D PICKENS Owner 734-992-7212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-05-12 |