| NPI | 1548436421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN FENWICK Director 313-389-7548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 6401005512) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2008-05-01 |