| NPI | 1629215769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE ANN PRADKO President 586-725-7686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301074972) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MI 4301060263) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2009-01-12 |