| NPI | 1891119566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABDELKADER H FARES Doctor 313-843-1973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI AF04301043357) |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2014-02-14 |