Provider First Line Business Practice Location Address:
4646 JOHN R. STREET
Provider Second Line Business Practice Location Address:
PHARMACY (118-CP)
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-676-4636
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006