Individual
MRS. LISA MARIE LONGORIA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17615 BAILEY RD, BAILEY, MI 49303-9729
(616) 914-7362
(231) 282-7057
Mailing address
17165 BAILEY RD, BAILEY, MI 49303-9729
(616) 914-7362
(231) 282-7057
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501002188
MI
Other
Enumeration date
03/11/2014
Last updated
03/11/2014
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