Provider First Line Business Practice Location Address:
248 E SAGINAW ST
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-2760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-203-2090
Provider Business Practice Location Address Fax Number:
517-203-2092
Provider Enumeration Date:
11/13/2006