Provider First Line Business Practice Location Address:
3120 CARPENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMTRAMCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48212-9802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-891-8246
Provider Business Practice Location Address Fax Number:
313-891-8247
Provider Enumeration Date:
03/12/2007