Provider First Line Business Practice Location Address:
1201 N TELEGRAPH RD
Provider Second Line Business Practice Location Address:
OAKLAND COUNTY JAIL
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-858-1812
Provider Business Practice Location Address Fax Number:
248-858-1695
Provider Enumeration Date:
01/26/2007