Provider First Line Business Practice Location Address:
1465 E PARKDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANISTEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49660-9709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-398-1000
Provider Business Practice Location Address Fax Number:
989-340-1214
Provider Enumeration Date:
07/28/2008