Provider First Line Business Practice Location Address:
612 W LAKE LANSING RD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-853-3797
Provider Business Practice Location Address Fax Number:
517-336-7737
Provider Enumeration Date:
12/06/2010