Registry details
Type
Individual
Primary specialty
Family Medicine
Enumerated
May 28, 2024
License(s)
4351052842 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 300 LAFAYETTE SE | Grand Rapids, MI 49503 | 616-685-6922 |
| MAILING | 200 JEFFERSON SE MEDICAL EDUCATION-SUITE 305 | Grand Rapids, MI 49503 | 616-685-6741 |
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