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Organization
SURBURBAN LLC
Active
Organization
SURBURBAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHARRISA NADINE WILLIAMS (OWNER)
(313) 837-0560
Entity
Organization
Contact information
Practice address
20905 GREENFIELD RD, SUITE 203, SOUTHFIELD, MI 48075-5360
(313) 837-0560
Mailing address
PO BOX 760128, LATHRUP VILLAGE, MI 48076-0128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/20/2009
Last updated
11/28/2012
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