Provider First Line Business Practice Location Address:
1151 TAYLOR ST DEPT OF
Provider Second Line Business Practice Location Address:
NUTRITION DEPARTMENT - 2C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-870-0011
Provider Business Practice Location Address Fax Number:
313-876-0539
Provider Enumeration Date:
10/21/2008