MARK A LARVA

GRAND RAPIDS, MI
NPI1508813890
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: MI  5601003190)
Enumeration Date2006-05-30
Last Update Date2011-11-02
Business Address
-- MARK A LARVA PA
100 MICHIGAN ST NE
GRAND RAPIDS, MI 49503-2560
Phone number: 616-391-1680
Mailing Address
-- MARK A LARVA PA
2537 MOMENTUM PL
CHICAGO, IL 60689-5325
Phone number: 616-975-1845
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