Provider First Line Business Practice Location Address:
4201 ST ANTOINE, STE. 8C-UCH
Provider Second Line Business Practice Location Address:
WAYNE STATE SCHOOL OF MEDICINE, DEPARTMENT OF NEUROLOGY
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-1302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2023