Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Mar 29, 2007
License(s)
5601004693 (MI), 5601004693 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 400 MACK AVE | Detroit, MI 48201-2136 | |
| LOCATION | 4201 SAINT ANTOINE ST | Detroit, MI 48201-2153 | 313-745-3000 |
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