Individual
LISA BURCHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5528 MICK AVE SE, KENTWOOD, MI 49548-5857
(616) 427-7935
Mailing address
5528 MICK AVE SE, KENTWOOD, MI 49548-5857
(616) 427-7935
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/08/2016
Last updated
10/08/2016
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