Provider First Line Business Practice Location Address:
12851 E GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
BRIGHTON HOSPITAL
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48116-9969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-225-2552
Provider Business Practice Location Address Fax Number:
810-227-2270
Provider Enumeration Date:
05/25/2006