Individual
CAROL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19401 NORTHLINE RD, SOUTHGATE, MI 48195-2277
(734) 785-7718
Mailing address
790 SAINT JOHNS BLVD, LINCOLN PARK, MI 48146-4926
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
07/14/2009
Last updated
07/14/2009
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