Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Mar 21, 2019
License(s)
4301509357 (MI), 101724 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2799 W GRAND BLVD | Detroit, MI 48202-2689 | 313-916-7425 |
| MAILING | 1 FORD PL STE 3A | Detroit, MI 48202-3450 | 313-874-4806 |
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