Provider First Line Business Practice Location Address:
2700 MLK JR BLVD
Provider Second Line Business Practice Location Address:
UNIVERSITY OF DETROIT MERCY ,SCHOOL OF DENTISTRY
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48208-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-494-6669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2012