Provider First Line Business Practice Location Address:
1500 E MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
2ND FLOOR C.S. MOTT CHILDRENS HOSPITAL
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48109-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-936-4230
Provider Business Practice Location Address Fax Number:
734-998-0037
Provider Enumeration Date:
06/22/2007