Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
Oct 21, 2005
License(s)
RA055555 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1740 E PARIS AVE SE | Grand Rapids, MI 49546-6204 | 616-949-5600 |
| MAILING | 1740 E PARIS AVE SE | Grand Rapids, MI 49546-6204 | 616-949-5600 |
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