Provider First Line Business Practice Location Address:
ONE FORD PLACE 2E
Provider Second Line Business Practice Location Address:
HENRY FORD HOSPITAL, DEPARTMENT OF FAMILY MEDICINE
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:
313-876-8319
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2016