Provider First Line Business Practice Location Address:
3496 E LAKE LANSING RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-2288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-333-0968
Provider Business Practice Location Address Fax Number:
517-333-4306
Provider Enumeration Date:
09/12/2007