Provider First Line Business Practice Location Address:
2799 WEST GRAND BLVD. K-11
Provider Second Line Business Practice Location Address:
HENRY FORD HOSPITAL
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-916-2682
Provider Business Practice Location Address Fax Number:
313-916-7139
Provider Enumeration Date:
07/07/2008