Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jul 4, 2018
License(s)
4301115099 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 313 N CEDAR ST APT 212 | Lansing, MI 48912-1289 | 571-645-0320 |
| LOCATION | 788 SERVICE RD | East Lansing, MI 48824-7013 | 517-432-2404 |
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