Individual
SANDRA LEE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4728 WOLF RUN AVE SE, KENTWOOD, MI 49548-7570
(616) 734-3204
Mailing address
4728 WOLF RUN AVE SE, KENTWOOD, MI 49548-7570
(616) 734-3204
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
MI
Other
Enumeration date
03/28/2024
Last updated
03/28/2024
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