Provider First Line Business Practice Location Address:
2113 N MARKEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUGHTON LAKE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48629-8335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-422-5813
Provider Business Practice Location Address Fax Number:
989-422-7163
Provider Enumeration Date:
06/29/2006