| NPI | 1770769630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAIZ MANSOUR Owner 248-334-3792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 4301059179) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2008-05-20 |