Provider First Line Business Practice Location Address:
11800 E 12 MILE ROAD
Provider Second Line Business Practice Location Address:
ST JOHN MACOMB HOSPITAL PT EDUCATION DEPT MEC
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-3472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-573-5697
Provider Business Practice Location Address Fax Number:
586-576-4119
Provider Enumeration Date:
05/30/2008