| NPI | 1972781359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINQUE BUCK Owner 734-728-5220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2008-02-07 |