Provider First Line Business Practice Location Address:
9249 W LAKE CITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUGHTON LAKE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48629-9602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-422-5122
Provider Business Practice Location Address Fax Number:
989-422-4378
Provider Enumeration Date:
12/16/2005