Provider First Line Business Practice Location Address:
5301 E HURON RIVER DR
Provider Second Line Business Practice Location Address:
ST. JOSEPH MERCY HOSPITAL DEPARTMENT OF PEDIATRICS
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-712-5880
Provider Business Practice Location Address Fax Number:
734-712-5525
Provider Enumeration Date:
03/27/2006