Provider First Line Business Practice Location Address:
1125 W RIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-225-4545
Provider Business Practice Location Address Fax Number:
906-225-7543
Provider Enumeration Date:
08/22/2007