Provider First Line Business Practice Location Address:
9650 WAYNE RD
Provider Second Line Business Practice Location Address:
BEAUMONT TEEN HEATLH CENTER -ROMULUS
Provider Business Practice Location Address City Name:
ROMULUS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-942-4857
Provider Business Practice Location Address Fax Number:
734-942-6734
Provider Enumeration Date:
11/16/2006