Individual
BURSHONDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13217 FRAZHO RD, WARREN, MI 48089-1302
(313) 977-7544
Mailing address
13217 FRAZHO RD, WARREN, MI 48089-1302
(313) 977-7544
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
OQLQ56
MI
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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