Provider First Line Business Practice Location Address:
2799 W GRAND BLVD
Provider Second Line Business Practice Location Address:
HENRY FORD HOSPITAL; K-8 ENT
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-363-7238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2018