Provider First Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF MI - 4TH
Provider Second Line Business Practice Location Address:
3901 BEAUBIEN
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-5481
Provider Business Practice Location Address Fax Number:
313-966-2423
Provider Enumeration Date:
05/13/2007