Provider First Line Business Practice Location Address:
1236 S MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48161-3934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-241-9533
Provider Business Practice Location Address Fax Number:
734-241-9108
Provider Enumeration Date:
06/10/2005