Provider First Line Business Practice Location Address:
529 N MONROE ST
Provider Second Line Business Practice Location Address:
CUSTOM COMPOUNDING PHARMACY
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-240-1514
Provider Business Practice Location Address Fax Number:
734-241-8422
Provider Enumeration Date:
10/18/2006