Provider First Line Business Practice Location Address:
230 BACKUS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEBOYGAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49721-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-627-6161
Provider Business Practice Location Address Fax Number:
231-627-2921
Provider Enumeration Date:
01/24/2007