| NPI | 1619581352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR MADISON Owner 313-826-0171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |