Provider First Line Business Practice Location Address:
1100 LUDINGTON ST
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
ESCANABA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-789-1596
Provider Business Practice Location Address Fax Number:
906-789-2024
Provider Enumeration Date:
01/23/2006