Provider First Line Business Practice Location Address:
GME OFFICE 4201 ST. ANTOINE, UHC-9C
Provider Second Line Business Practice Location Address:
DETROIT MEDICAL CENTER
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-966-0945
Provider Business Practice Location Address Fax Number:
313-993-7118
Provider Enumeration Date:
06/10/2021