Provider First Line Business Practice Location Address:
18101 OAKWOOD BLVD
Provider Second Line Business Practice Location Address:
ISU OBSERVATION UNIT
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-4089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-982-5770
Provider Business Practice Location Address Fax Number:
313-982-5771
Provider Enumeration Date:
11/02/2011