Registry details
Type
Individual
Primary specialty
Dermatology, MOHS-Micrographic Surgery
Enumerated
Jul 29, 2009
License(s)
4301110922 (MI), 4301110922 (MI), 4301110922 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 801 YORK ST | Manitowoc, WI 54220-4630 | 920-663-9008 |
| LOCATION | 2525 E PARIS AVE SE STE 100 | Grand Rapids, MI 49546-6191 | 616-678-2070 |
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