Provider First Line Business Practice Location Address:
7800 W OUTER DRIVE
Provider Second Line Business Practice Location Address:
HENRY FORD NORTHWEST PHARMACY
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-653-2039
Provider Business Practice Location Address Fax Number:
313-255-2091
Provider Enumeration Date:
11/21/2006