Provider First Line Business Practice Location Address:
261 MACK AVE
Provider Second Line Business Practice Location Address:
REHABILITATION INSTITUTE OF MICHIGAN, RM 552
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-993-8085
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2005