Provider First Line Business Practice Location Address:
16001 W 9 MILE RD
Provider Second Line Business Practice Location Address:
DEPT OF INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-849-3152
Provider Business Practice Location Address Fax Number:
248-849-5378
Provider Enumeration Date:
11/07/2005