Individual
KELLY J STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1060 W NORTON AVE, MUSKEGON, MI 49441-4175
(231) 777-2222
Mailing address
15126 160TH AVE, GRAND HAVEN, MI 49417-8922
(616) 638-3818
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/01/2018
Last updated
11/01/2018
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