Provider First Line Business Practice Location Address:
24601 NORTHWESTERN HWY
Provider Second Line Business Practice Location Address:
BILLING DEPT.
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-827-4580
Provider Business Practice Location Address Fax Number:
248-827-7663
Provider Enumeration Date:
09/20/2005