Organization
TARGET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY FORTUNE (SUPERVISOR)
(248) 508-1393
Entity
Organization
Contact information
Practice address
43670 FORD RD, CANTON, MI 48187-3101
(734) 454-2507
Mailing address
43670 FORD RD, CANTON, MI 48187-3101
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
5302033218
MI
Other
Enumeration date
12/02/2011
Last updated
12/02/2011
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