Provider First Line Business Practice Location Address:
1500 E. MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
C213 MED INN BUILDING, BOX 0824
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48109-0824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-936-7922
Provider Business Practice Location Address Fax Number:
734-936-6585
Provider Enumeration Date:
06/15/2007