Provider First Line Business Practice Location Address:
139 W LAKE LANSING RD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-337-1832
Provider Business Practice Location Address Fax Number:
517-337-1854
Provider Enumeration Date:
06/24/2008