Provider First Line Business Practice Location Address:
140 RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-264-8176
Provider Business Practice Location Address Fax Number:
231-264-8173
Provider Enumeration Date:
11/15/2006