| NPI | 1518375294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LORRAINE LEWIS Chief Executive Officer 313-595-3125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 6401012459) |
| Enumeration Date | 2014-07-26 |
| Last Update Date | 2014-07-26 |