Provider First Line Business Practice Location Address:
9166 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-422-3312
Provider Business Practice Location Address Fax Number:
989-422-6145
Provider Enumeration Date:
08/15/2005