Provider First Line Business Practice Location Address:
1106 N CEDAR ST.
Provider Second Line Business Practice Location Address:
SUITE 200B
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-492-4818
Provider Business Practice Location Address Fax Number:
517-492-4896
Provider Enumeration Date:
06/28/2006