Provider First Line Business Practice Location Address:
2601 COOLIDGE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-6361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-913-4050
Provider Business Practice Location Address Fax Number:
517-333-0893
Provider Enumeration Date:
04/12/2007