Provider First Line Business Practice Location Address:
802 W LAKE LANSING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-316-1277
Provider Business Practice Location Address Fax Number:
517-316-2102
Provider Enumeration Date:
11/21/2006