| NPI | 1962770172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY FORTUNE Supervisor 248-508-1393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: MI 5302033218) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2011-12-02 |