Provider First Line Business Practice Location Address: 
OAKWOOD HEALTHCARE - MERCURY DRIVE
    Provider Second Line Business Practice Location Address: 
4900 MERCURY DR., SUITE 201
    Provider Business Practice Location Address City Name: 
DEARBORN
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
48126
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
313-982-4351
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/14/2007