Provider First Line Business Practice Location Address:
9222 JOSEPH CAMPAU ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
HAMTRAMCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48212-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-872-6080
Provider Business Practice Location Address Fax Number:
313-872-6111
Provider Enumeration Date:
10/18/2006