Provider First Line Business Practice Location Address:
400 ALLEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48912-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-974-6762
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2026