Provider First Line Business Practice Location Address:
1423 FIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48214-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-879-5023
Provider Business Practice Location Address Fax Number:
313-821-5759
Provider Enumeration Date:
03/24/2015