Provider First Line Business Practice Location Address:
643 E LAKE ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
HARBOR SPRINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49740-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-242-4734
Provider Business Practice Location Address Fax Number:
231-242-4700
Provider Enumeration Date:
05/22/2007