Provider First Line Business Practice Location Address:
3448 E LAKE LANSING RD
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:
48823-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-332-3870
Provider Business Practice Location Address Fax Number:
517-332-9247
Provider Enumeration Date:
10/02/2006