| NPI | 1881955953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS C JORGE Owner 313-359-9361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: MI 4301038699) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2014-09-18 |