Provider First Line Business Practice Location Address:
1151 TAYLOR STREET
Provider Second Line Business Practice Location Address:
HERMAN KIEFER HEALTH COMPLEX 150-C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-876-4222
Provider Business Practice Location Address Fax Number:
313-876-4221
Provider Enumeration Date:
07/02/2008