Provider First Line Business Practice Location Address:
ASCENSION PROVIDENCE HOSPITAL
Provider Second Line Business Practice Location Address:
16001 W NINE MILE ROAD
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-3000
Provider Business Practice Location Address Fax Number:
248-338-5564
Provider Enumeration Date:
04/14/2011