Provider First Line Business Practice Location Address:
PORTAGE NORTHERN HIGH SCHOOL
Provider Second Line Business Practice Location Address:
1000 IDAHO AVE
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-323-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2018