Provider First Line Business Practice Location Address:
138 SERVICE RD
Provider Second Line Business Practice Location Address:
A225 CLINICAL CENTER
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-1376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-353-4941
Provider Business Practice Location Address Fax Number:
517-432-3145
Provider Enumeration Date:
05/24/2011