Individual
KIRSTEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
20031 CARLYSLE ST, SUITE 3, DEARBORN, MI 48124-3803
(313) 277-9170
(313) 277-9176
Mailing address
4204 MARTIN RD, SUITE A, COMMERCE TOWNSHIP, MI 48390-4135
(248) 366-9170
(248) 366-9176
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5501004619
MI
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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