Individual
SHANNON BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
103 PARKHURST STREET, PONTIAC, MI 48342
(248) 425-5053
Mailing address
103 PARKHURST STREET, PONTIAC, MI 48342
(248) 425-5053
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
07/29/2016
Last updated
07/29/2016
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