| NPI | 1699199554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMITKO L MOORE Administrative Assistant 248-864-8290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-02-13 |