| NPI | 1568114973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINA UNDERWOOD Owner 313-635-5735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-05-18 |