Provider First Line Business Practice Location Address:
4269 W M-80
Provider Second Line Business Practice Location Address:
CHIPPEWA CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
KINCHELOE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49784-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-495-2275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2007