| NPI | 1689861114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA YVONNE CRAWFORD Owner/Practioner 248-798-1657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI bus200600893) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2017-01-31 |