Provider First Line Business Practice Location Address:
4201 ST. ANTOINE - UHC 5D #226
Provider Second Line Business Practice Location Address:
UNIVERSITY PEDIATRICIANS
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-4405
Provider Business Practice Location Address Fax Number:
313-966-0665
Provider Enumeration Date:
06/14/2010