Provider First Line Business Practice Location Address:
5760 WEST HOUGHTON LAKE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49651-0430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-839-5800
Provider Business Practice Location Address Fax Number:
231-839-2206
Provider Enumeration Date:
01/11/2007