Provider First Line Business Practice Location Address:
1595 W LAKE LANSING RD STE 130
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:
48823-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-333-6692
Provider Business Practice Location Address Fax Number:
517-333-6705
Provider Enumeration Date:
12/09/2014