Provider First Line Business Practice Location Address: 
SAGINAW VALLEY STATE UNIVERSITY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
UNIVERSITY CENTER
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
48710-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
801-626-6211
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/03/2006