Individual
MS. SUZETTE M GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INDIVIDUAL
Contact information
Practice address
860 TIBBETTSTOWN RD, COLUMBIA FALLS, ME 04623-5021
(207) 483-2883
Mailing address
860 TIBBETTSTOWN RD, COLUMBIA FALLS, ME 04623-5021
(207) 483-2883
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
3002032
ME
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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