Provider First Line Business Practice Location Address:
2799 W GRAND BLVD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF NEUROLOGY, K-11
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-375-2170
Provider Business Practice Location Address Fax Number:
248-325-3125
Provider Enumeration Date:
07/08/2009