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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
SALLY CHODOBA (TRAINER)
(248) 860-5749
Entity
Organization

Contact information

Practice address
175 N. GRORSEBECK HWY, MT. CLEMENS, MI 48043
(586) 627-0024
(586) 624-0027
Mailing address
175 N. GRORSEBECK HWY, MT. CLEMENS, MI 48043
(586) 627-0024
(586) 624-0027

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary

Other

Enumeration date
11/06/2012
Last updated
11/07/2012
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