Organization
MALIBU GROUP LLC
Active
Other names
Remedy Lice Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
CORINN NICHOLS (MANAGER)
(616) 450-4125
Entity
Organization
Contact information
Practice address
5258 PLAINFIELD AVE NE, GRAND RAPIDS, MI 49525-1092
(616) 635-2398
Mailing address
4075 YARROW DR NE, GRAND RAPIDS, MI 49525-9531
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/27/2017
Last updated
11/27/2017
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