Provider First Line Business Practice Location Address:
ASCENSION PROVIDENCE HOSPITAL SOUTHFIELD CAMPUS
Provider Second Line Business Practice Location Address:
16001 W. NINE MILE RD. DEPAUL 2ND FLOOR
Provider Business Practice Location Address City Name:
SOUTHFIELD, MI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-3415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2020