Provider First Line Business Practice Location Address:
4210 SAINT ANTOINE ST
Provider Second Line Business Practice Location Address:
UNIVERSITY HEALTH CENTER 7C
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-577-5222
Provider Business Practice Location Address Fax Number:
313-577-5217
Provider Enumeration Date:
04/07/2015