Provider First Line Business Practice Location Address:
38 4TH ST
Provider Second Line Business Practice Location Address:
FLORENCE CRANE CORRECTIONAL COMPLEX
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49036-8607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-279-9165
Provider Business Practice Location Address Fax Number:
517-279-6215
Provider Enumeration Date:
09/12/2007