Individual
KIMBERLY DEBORAH WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 966-7821
Mailing address
7209 LESTER ST, LEXINGTON, MI 48450-8847
(810) 966-7821
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/28/2009
Last updated
10/28/2009
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