Provider First Line Business Practice Location Address:
2500 E GRAND BLVD
Provider Second Line Business Practice Location Address:
MEDICAL DEPT
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48211-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-972-6202
Provider Business Practice Location Address Fax Number:
313-972-6094
Provider Enumeration Date:
02/07/2014