Organization
STALLWORTH AFC #1 CORPORATION
Active
Other names
stallworth afc
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAIL STALLWORTH (ADMINISTRATOR)
(313) 319-5526
Entity
Organization
Contact information
Practice address
645 E GRAND BLVD, DETROIT, MI 48207-3512
(313) 319-5526
(313) 823-8284
Mailing address
P.O. BOX 07250, DETROIT, MI 48207
(313) 319-5526
(313) 823-8284
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
MI
Other
Enumeration date
10/26/2006
Last updated
08/22/2020
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