Provider First Line Business Practice Location Address:
2799 W. GRAND BLVD, K-14, B1451
Provider Second Line Business Practice Location Address:
HENRY FORD HOSPITAL
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-916-2966
Provider Business Practice Location Address Fax Number:
313-916-8799
Provider Enumeration Date:
03/05/2007