Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Mar 18, 2026
License(s)
—
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 259 MACK AVE | Detroit, MI 48201-2427 | 313-577-2424 |
| MAILING | 259 MACK AVE | Detroit, MI 48201-2427 |
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