Provider First Line Business Practice Location Address:
4160 JOHN R ST STE 1007
Provider Second Line Business Practice Location Address:
DMC ENT-HARPER PROFESSIONAL BUILDING
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-966-9471
Provider Business Practice Location Address Fax Number:
313-966-9470
Provider Enumeration Date:
08/25/2010