Provider First Line Business Practice Location Address:
1500 EAST MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
3RD FLOOR C.S. MOTT CHILDREN'S HOSPITAL
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48109-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-936-7010
Provider Business Practice Location Address Fax Number:
734-936-9294
Provider Enumeration Date:
01/31/2013