Individual
MS. GLORIA JEAN BRASWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
223 HARBOR LAKE DRIVE, FENNVILLE, MI 49408
(269) 857-8636
(269) 857-8636
Mailing address
PO BOX 293, BANGOR, MI 49013-0293
(269) 427-9006
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/28/2009
Last updated
12/19/2011
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