Provider First Line Business Practice Location Address:
5400 EAST 7 MILE
Provider Second Line Business Practice Location Address:
NORTHEAST HEALTH CENTER ROOM 17
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-870-3052
Provider Business Practice Location Address Fax Number:
313-368-4694
Provider Enumeration Date:
07/11/2008