| NPI | 1598214389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYELLEN LIENING Clinical Instructor 313-577-3339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MI 7101001401) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |