Provider First Line Business Practice Location Address:
1525 W. LAKE LANSING
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-336-5636
Provider Business Practice Location Address Fax Number:
517-336-5638
Provider Enumeration Date:
10/03/2006