| NPI | 1972835205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL T DEGUZMAN Director 734-459-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MI 4301033522) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2010-02-11 |