Provider First Line Business Practice Location Address:
3901 BEAUBIEN ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHOLOGY, BOX 137
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-4878
Provider Business Practice Location Address Fax Number:
313-993-0282
Provider Enumeration Date:
09/03/2013