NPI | 1588078943 |
---|---|
Entity Type | Organization |
Authorized Contact | LARRY HERMAN REID President 248-424-9749 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 5101007121) |
Enumeration Date | 2014-06-13 |
Last Update Date | 2014-06-13 |