Provider First Line Business Practice Location Address:
1350 E LAKE LANSING RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-7413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-351-7222
Provider Business Practice Location Address Fax Number:
517-351-2516
Provider Enumeration Date:
05/10/2006