Provider First Line Business Practice Location Address:
115 SOUTH ST
Provider Second Line Business Practice Location Address:
MICHIGAN COMMUNITY MEDICAL CLINIC
Provider Business Practice Location Address City Name:
MICHIGAN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58259-0290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-259-2119
Provider Business Practice Location Address Fax Number:
701-259-2319
Provider Enumeration Date:
10/19/2006