Provider First Line Business Practice Location Address:
22101 MOROSS ROAD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-343-8797
Provider Business Practice Location Address Fax Number:
313-343-7620
Provider Enumeration Date:
05/30/2007