Individual
CONNER VICTORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24445 NORTHWESTERN HWY, SOUTHFIELD, MI 48075-6501
(248) 483-7804
Mailing address
1719 RIVER RD, EAST CHINA, MI 48054-1592
(586) 940-4920
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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