Provider First Line Business Practice Location Address: 
8303 PLATT RD
    Provider Second Line Business Practice Location Address: 
CENTER FOR FORENSIC PSYCHIATRY
    Provider Business Practice Location Address City Name: 
SALINE
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
48176-9773
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
734-429-2531
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/14/2009