Individual
BRIA LATOYA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
479 VISGER RD, ECORSE, MI 48229-1365
(313) 595-5496
Mailing address
PO BOX 1352, LINCOLN PARK, MI 48146-7152
(313) 236-0880
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/29/2016
Last updated
07/18/2024
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