Provider First Line Business Practice Location Address:
1 CAMPUS DR
Provider Second Line Business Practice Location Address:
GRAND VALLEY STATE UNIVERSITY, 84 FIELD HOUSE
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49401-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-331-3329
Provider Business Practice Location Address Fax Number:
616-331-3232
Provider Enumeration Date:
02/15/2006