Provider First Line Business Practice Location Address: 
4949 COOLIDGE HIGHWAY
    Provider Second Line Business Practice Location Address: 
SECTION E- NEURO-REHABILITATION
    Provider Business Practice Location Address City Name: 
ROYAL OAK
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
48073
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
248-655-5800
    Provider Business Practice Location Address Fax Number: 
248-655-5801
    Provider Enumeration Date: 
03/07/2018