Individual
GINA RENEE BASS-MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 985-8900
Mailing address
3111 ELECTRIC AVE, PORT HURON, MI 48060-8127
(810) 985-8900
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
05/25/2018
Last updated
05/25/2018
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