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1669130480
AUSTIN GRESHAM OUTLAW
GRAND RAPIDS, MI
NPI
1669130480
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2021-11-30
Last Update Date
2021-11-30
Business Address
AUSTIN GRESHAM OUTLAW
4218 BURTON ST SE
GRAND RAPIDS, MI 49546-6121
Phone number: 616-301-8000
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Mailing Address
AUSTIN GRESHAM OUTLAW
735 E SHAW LN
EAST LANSING, MI 48825-3802
Phone number: 269-425-0756
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