| 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 |