Provider First Line Business Practice Location Address:
G1213 N. BALLENGER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48504-4435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-239-7475
Provider Business Practice Location Address Fax Number:
810-239-7477
Provider Enumeration Date:
12/27/2005