Provider First Line Business Practice Location Address:
401 S BALLENGER HWY
Provider Second Line Business Practice Location Address:
ATTN NUTRITIONAL SERVICES
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-342-2187
Provider Business Practice Location Address Fax Number:
810-342-3696
Provider Enumeration Date:
11/28/2006