Provider First Line Business Practice Location Address:
SOUTHEASTERN HIGH SCHOOL
Provider Second Line Business Practice Location Address:
3030 FAIRVIEW
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-866-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2022