Provider First Line Business Practice Location Address:
3901 BEAUBIEN ST
Provider Second Line Business Practice Location Address:
PEDIATRIC NEPHROLOGY,CHILDREN'S HOSPITAL OF MICHIGAN
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-5604
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2007