Provider First Line Business Practice Location Address:
4201 ST ANTIONE
Provider Second Line Business Practice Location Address:
DETROIT MEDICAL CENTER
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-6507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-464-0887
Provider Business Practice Location Address Fax Number:
734-402-0254
Provider Enumeration Date:
05/22/2009