Provider First Line Business Practice Location Address:
4201, ST ANTOINE
Provider Second Line Business Practice Location Address:
UMIVERSTY HEALTH CENTER 2E
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:
313-745-5146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2026