Provider First Line Business Practice Location Address:
G 1071 N BALLENGER HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-235-0668
Provider Business Practice Location Address Fax Number:
810-235-8928
Provider Enumeration Date:
08/01/2006