Provider First Line Business Practice Location Address:
15885 19 MILE
Provider Second Line Business Practice Location Address:
HENRY FORD MACOMB HOSPITAL
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-464-0887
Provider Business Practice Location Address Fax Number:
734-402-0254
Provider Enumeration Date:
07/15/2010