Provider First Line Business Practice Location Address:
223 KALAMAZOO ST
Provider Second Line Business Practice Location Address:
JENISON FIELD HOUSE ATHLETIC TRAINING ROOM 106
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-355-1627
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2015