Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jun 30, 2011
License(s)
CDR.0000654 (CO), 036.152224 (IL), 2162 (NE), 05-43057 (KS), 5101019296 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1000 HARRINGTON ST | Mount Clemens, MI 48043-2920 | 586-493-8195 |
| MAILING | 4967 CROOKS RD STE 130 | Troy, MI 48098-5801 | 248-952-1601 |
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