Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
May 23, 2011
License(s)
43011092914 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 26660 BERG RD APT 1807 | Southfield, MI 48033-5387 | |
| LOCATION | 16001 WEST NINE MILE RD | Southfield, MI 48075-4803 | 248-849-2203 |
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