| NPI | 1538598115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE BRAGG-LOVE JOY Executive Director 586-627-0024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 4704284704) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |