Provider First Line Business Practice Location Address:
1401 E LANSING DR
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-7787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-351-8881
Provider Business Practice Location Address Fax Number:
517-351-8883
Provider Enumeration Date:
09/28/2006