| NPI | 1689184020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA WEAVER Office Manager 313-581-3255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: MI 5101015792) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2018-12-17 |