Individual
AMBER DRAFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9684 LEONARD ST, COOPERSVILLE, MI 49404-9697
(616) 405-3848
Mailing address
9684 LEONARD ST, COOPERSVILLE, MI 49404-9697
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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