Provider First Line Business Practice Location Address:
4210 SAINT ANTOINE ST
Provider Second Line Business Practice Location Address:
UHC 9C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-5147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2014