Individual
LAURA LEIGH THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 S WESTPHALIA ST, WESTPHALIA, MI 48894-9810
(517) 281-2380
Mailing address
201 S WESTPHALIA ST, WESTPHALIA, MI 48894-9810
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5502001690
MI
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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