Individual
EBONY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 CHENE ST APT 611, DETROIT, MI 48207-3855
(313) 595-2748
Mailing address
20232 HANNA ST, DETROIT, MI 48203-1223
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
09/18/2015
Last updated
09/22/2015
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