Provider First Line Business Practice Location Address:
6225 PRAIRIE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-798-9500
Provider Business Practice Location Address Fax Number:
231-798-9533
Provider Enumeration Date:
03/29/2007