Provider First Line Business Practice Location Address:
3663 WOODWARD AVE STE 200
Provider Second Line Business Practice Location Address:
WSU DETROIT MEDICAL CENTER
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-8875
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2009