Provider First Line Business Practice Location Address:
411 W LAKE LANSING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-336-7366
Provider Business Practice Location Address Fax Number:
517-336-0808
Provider Enumeration Date:
01/03/2007