| NPI | 1922369420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE LYNN HENDRIX Cna.Bls.Cpr.First Aid 313-316-9908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MI 302f00000x) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |