Provider First Line Business Practice Location Address: 
3225 US 41 WEST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MARQUETTE
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
49855
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
906-226-5015
    Provider Business Practice Location Address Fax Number: 
906-226-5055
    Provider Enumeration Date: 
10/09/2014