Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Apr 21, 2006
License(s)
5101012667 (MI), 5101012667 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 15101 SOUTHFIELD RD SUITE 101 | Allen Park, MI 48101-2697 | 313-383-3333 |
| MAILING | 22171 NOWLIN ST | Dearborn, MI 48124-2732 | 313-414-3545 |
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