Individual
MR. MASON GRANDVILLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 966-3566
Mailing address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 966-3566
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/09/2020
Last updated
03/09/2020
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