Individual
TERRI DALLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
59 SEWARD ST APT 603, DETROIT, MI 48202-2431
(313) 773-5073
Mailing address
19319 STAHELIN AVE, DETROIT, MI 48219-2713
(810) 986-1723
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
11/12/2019
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