Provider First Line Business Practice Location Address:
1806 E PARKDALE AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANISTEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49660-9364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-843-0075
Provider Business Practice Location Address Fax Number:
231-843-0080
Provider Enumeration Date:
08/21/2006