Provider First Line Business Practice Location Address:
415 W GRAND RIVER AVE
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:
48823-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-333-0173
Provider Business Practice Location Address Fax Number:
517-333-8777
Provider Enumeration Date:
04/25/2007