Provider First Line Business Practice Location Address:
3496 E LAKE LANSING RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-6222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-485-1967
Provider Business Practice Location Address Fax Number:
517-485-6919
Provider Enumeration Date:
12/26/2006