Provider First Line Business Practice Location Address:
1331 E GRAND RIVER AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-4988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-992-1367
Provider Business Practice Location Address Fax Number:
989-220-4990
Provider Enumeration Date:
10/01/2026