Provider First Line Business Practice Location Address:
804 CLINICAL CENTER
Provider Second Line Business Practice Location Address:
A114
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-355-7648
Provider Business Practice Location Address Fax Number:
517-432-1390
Provider Enumeration Date:
11/02/2006