Provider First Line Business Practice Location Address:
8145 FENKELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48238-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-742-1622
Provider Business Practice Location Address Fax Number:
313-836-1315
Provider Enumeration Date:
10/05/2009