Provider First Line Business Practice Location Address:
10100 HARPER AVE
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:
48213-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-921-9422
Provider Business Practice Location Address Fax Number:
313-571-9022
Provider Enumeration Date:
03/15/2007