Provider First Line Business Practice Location Address:
4201 ST ANTIONE
Provider Second Line Business Practice Location Address:
DETROIT MEDICAL CENTER GME OFFICE
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-235-7381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2020