Provider First Line Business Practice Location Address: 
202 MORSE ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
COLDWATER
    Provider Business Practice Location Address State Name: 
MI
    Provider Business Practice Location Address Postal Code: 
49036-1477
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
517-279-7531
    Provider Business Practice Location Address Fax Number: 
517-278-3154
    Provider Enumeration Date: 
06/27/2011