Provider First Line Business Practice Location Address:
U OF M SCHOOL OF DENTISTRY, 1011 N UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
PEDIATRIC CLINIC, ROOM 2075
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-764-1523
Provider Business Practice Location Address Fax Number:
734-615-7294
Provider Enumeration Date:
05/16/2011