Provider First Line Business Practice Location Address:
700 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-4163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-225-5585
Provider Business Practice Location Address Fax Number:
906-225-5990
Provider Enumeration Date:
12/22/2005