Provider First Line Business Practice Location Address:
3000 OLD CENTRE ROAD
Provider Second Line Business Practice Location Address:
SOUTHWEST MICHIGAN DERMATOLOGY, A DIVISION OF PARAGON H
Provider Business Practice Location Address City Name:
PORTAGE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-321-7546
Provider Business Practice Location Address Fax Number:
269-321-1705
Provider Enumeration Date:
08/23/2007