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Individual

MRS. JOYCE LEE PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
06/01/1964

Contact information

Practice address
328 EDGELL ST, SOUTH HAVEN, MI 49090-1716
(269) 637-4823
Mailing address
328 EDGELL ST, SOUTH HAVEN, MI 49090-1716
(269) 637-4823

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
AS800362293
MI

Other

Enumeration date
05/07/2016
Last updated
05/07/2016
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