| NPI | 1912200858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGH MARIE LIBERATORE Clinic Manager 248-971-2180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: MI 171W00000X) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |