Provider First Line Business Practice Location Address: 
MICHIGAN STATE UNIVERSITY PSYCHIATRIC RESIDENCY
    Provider Second Line Business Practice Location Address: 
965 FEE ROAD, ROOM A233
    Provider Business Practice Location Address City Name: 
EAST LANSING
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
48824
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
517-353-4362
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/25/2019