Provider First Line Business Practice Location Address:
5515 CLEVELAND AVENUE
Provider Second Line Business Practice Location Address:
LAKELAND MEDICAL PRACTICES DBA SWMC
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49127-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
261-429-9644
Provider Business Practice Location Address Fax Number:
269-429-4002
Provider Enumeration Date:
10/06/2005