Provider First Line Business Practice Location Address:
4201 ST. ANTOINE STE 6A & 6B
Provider Second Line Business Practice Location Address:
GENERAL MEDICINE AMBULATORY PRACTICE
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-4627
Provider Business Practice Location Address Fax Number:
313-966-7305
Provider Enumeration Date:
10/28/2008