Provider First Line Business Practice Location Address:
1560 E MAPLE RD
Provider Second Line Business Practice Location Address:
SUITE 400 - CREDENTIALING DEPARTMENT
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-527-6266
Provider Business Practice Location Address Fax Number:
313-576-8381
Provider Enumeration Date:
03/29/2007