Provider First Line Business Practice Location Address:
1465 E PARKDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANISTEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49660-9785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-398-1000
Provider Business Practice Location Address Fax Number:
231-398-0364
Provider Enumeration Date:
10/02/2006