Individual
CHARLES DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5536 S CLARENDON ST, DETROIT, MI 48204-2929
(313) 510-3961
Mailing address
5536 S CLARENDON ST, DETROIT, MI 48204-2929
(313) 510-3961
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
D250115108270
MI
Other
Enumeration date
10/26/2010
Last updated
10/26/2010
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