Provider First Line Business Practice Location Address:
200 JEFFERSON SE
Provider Second Line Business Practice Location Address:
ST MARYS HEALTH SERVICE PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-774-0209
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006