Provider First Line Business Practice Location Address:
2799 W. GRAND BLVD
Provider Second Line Business Practice Location Address:
HENRY FORD HOSPITAL
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-874-6611
Provider Business Practice Location Address Fax Number:
313-874-6655
Provider Enumeration Date:
04/08/2016