Provider First Line Business Practice Location Address:
1150 E LANTZ ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48203-1376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-368-4139
Provider Business Practice Location Address Fax Number:
313-368-4470
Provider Enumeration Date:
07/04/2006