Provider First Line Business Practice Location Address:
MICHIGAN STATE UNIVERSITY DEPT OF ATHLETICS
Provider Second Line Business Practice Location Address:
#131 DUFFY DAUGHERTY FB BLDG
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-353-4369
Provider Business Practice Location Address Fax Number:
517-432-2137
Provider Enumeration Date:
02/16/2007