Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
Sep 20, 2006
License(s)
4301056286 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 804 SERVICE RD ROOM A142 | East Lansing, MI 48824-1313 | 517-353-3050 |
| MAILING | 804 SERVICE RD # A201 | East Lansing, MI 48824-7015 | 517-884-2976 |
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