Provider First Line Business Practice Location Address:
9374 SCOTT HALL 540 E CANFIELD AVE
Provider Second Line Business Practice Location Address:
WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-577-1335
Provider Business Practice Location Address Fax Number:
313-577-8777
Provider Enumeration Date:
06/07/2006