Provider First Line Business Practice Location Address:
532 N OLD WOODWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-5375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-644-3414
Provider Business Practice Location Address Fax Number:
248-644-1012
Provider Enumeration Date:
10/31/2006