Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Apr 24, 2015
License(s)
4301505497 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5141 VIRGINIA WAY STE 350 | Brentwood, TN 37027-2319 | 855-744-8554 |
| LOCATION | 37605 PEMBROKE AVE | Livonia, MI 48152-1050 | 834-591-7931 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.