Individual
ALICIA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4569 BROOKLYN AVE SE, GRAND RAPIDS, MI 49508-4509
(248) 882-6401
Mailing address
4569 BROOKLYN AVE SE, GRAND RAPIDS, MI 49508-4509
(248) 882-6401
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/29/2016
Last updated
06/29/2016
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