Provider First Line Business Practice Location Address:
G1071 N BALLENGER HIGHWAY
Provider Second Line Business Practice Location Address:
PARK PLAZA SUITE 206
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48504-4453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-234-1651
Provider Business Practice Location Address Fax Number:
810-424-3912
Provider Enumeration Date:
08/11/2005