Individual
DARNETTA MAE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19154 DEQUINDRE ST, DETROIT, MI 48234-1208
(313) 622-9005
Mailing address
19154 DEQUINDRE ST, DETROIT, MI 48234-1208
(313) 622-9005
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
08/08/2016
Last updated
08/08/2016
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