Provider First Line Business Practice Location Address:
316 PHYSICS RD. MICHIGAN STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
ROOM 151
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48824-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-355-9564
Provider Business Practice Location Address Fax Number:
517-353-5437
Provider Enumeration Date:
05/11/2012