| NPI | 1962879890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD MONTRIEF CFO 734-926-4935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2020-12-17 |