Provider First Line Business Practice Location Address:
16001 WEST 9 MILE RD.
Provider Second Line Business Practice Location Address:
3 FL FISCHER CTR PROVIDENCE HOSP. CRANIOFACIAL INST.
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-5800
Provider Business Practice Location Address Fax Number:
248-849-5881
Provider Enumeration Date:
04/18/2007