Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 26, 2013
License(s)
2020-03854 (NC), 4301504261 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 3264 N EVERGREEN DR NE | Grand Rapids, MI 49525-9746 | 616-363-7272 |
| MAILING | 3264 N EVERGREEN DR NE | Grand Rapids, MI 49525-9746 | 616-363-7272 |
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