| NPI | 1629616511 |
|---|---|
| Doing Business As | TAYLOR STREET PRIMARY CARE CLINIC |
| Entity Type | Organization |
| Authorized Contact | GLORIA SMITH Chief Nursing Officer 313-577-5118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2019-12-11 |
| Last Update Date | 2019-12-11 |