| NPI | 1649706284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA H.F PETERS Executive Director 248-685-2639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |