Provider First Line Business Practice Location Address:
301 W MAIN ST
Provider Second Line Business Practice Location Address:
42ND CIRCUIT CT. JUVENILE COURT
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48640-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-832-6855
Provider Business Practice Location Address Fax Number:
989-832-6607
Provider Enumeration Date:
01/16/2007