Provider First Line Business Practice Location Address:
1112 S LAPEER RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-245-1111
Provider Business Practice Location Address Fax Number:
810-245-8750
Provider Enumeration Date:
01/26/2009