| NPI | 1780312397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTY SHELTON Chief Administration Officer 313-202-8660 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-08-11 |