| NPI | 1881904605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS T PARK President 248-552-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 4301040933) |
| Enumeration Date | 2010-10-14 |
| Last Update Date | 2010-10-14 |