Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
May 23, 2007
License(s)
4301045038 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 2232 S MAIN ST # 312 | Ann Arbor, MI 48103-6938 | 734-930-6303 |
| LOCATION | 4433 BRETON RD SE | Kentwood, MI 49508-5273 | 616-281-6000 |
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