Provider First Line Business Practice Location Address:
MEN'S BASKETBALL OFFICE
Provider Second Line Business Practice Location Address:
534 BIRCH RD. SUITE 150
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-4882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-256-8960
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007