Provider First Line Business Practice Location Address:
A110 CLINICAL CTR
Provider Second Line Business Practice Location Address:
138 SERVICE RD
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-353-3003
Provider Business Practice Location Address Fax Number:
517-353-5514
Provider Enumeration Date:
06/26/2006