Provider First Line Business Practice Location Address:
3225 JOHN CONLEY DR
Provider Second Line Business Practice Location Address:
THUMB CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
LAPEER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48446-2987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-667-2045
Provider Business Practice Location Address Fax Number:
810-667-6732
Provider Enumeration Date:
10/02/2006