Provider First Line Business Practice Location Address:
2300 HAGGERTY RD. STE 2190
Provider Second Line Business Practice Location Address:
LAKES MEDICAL CENTER
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-960-5604
Provider Business Practice Location Address Fax Number:
586-751-3505
Provider Enumeration Date:
11/30/2015