Provider First Line Business Practice Location Address:
804 SERVICE ROAD SUITE A 225
Provider Second Line Business Practice Location Address:
MICHIGAN STATE UNIVERSITY CLINICAL CENTER
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-353-4941
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2009