Provider First Line Business Practice Location Address:
2843 E GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
BOX 260
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-6722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-206-1388
Provider Business Practice Location Address Fax Number:
517-708-3081
Provider Enumeration Date:
11/15/2012